Prevalence: About 1000 cases of pill-induced esophageal injury (pill esophagitis) has been reported from 100 different pill types. Large amount of underreporting.

Mechanism: When a pill/capsule fails to pass into stomach and remains in contact with esophageal mucosa for extended period. This leads to inflammation and injury. Spectrum of injury can range from irritation to ulceration to hemorrhage to stricture formation.

Patient Risk Factors:

• Advanced Age
• Decreased esopheageal motility
• Extrinsic compression
• Taking pills without water
• Taking pills in supine position

Pill Risk Factors:

• Larger pills
• Gelatin coated pills
• Sustained-release compounds
• Antibiotics/Antivirals
• NSAIDs
• Potassium Chloride
• Quinidine
• Ferrous sulfate
• Alendronate/Pamidronate

Diagnosis: Largely based on history. Pill esophagitis is a diagnosis of exclusion in the Emergency Department. These patients may need non-emergent endoscopy.

Treatment:

• Antacid medication may prevent further irritation
• Instruct patients to take 4 ounces of liquid with pills and in upright position
• Remain upright sever minutes after ingestion
• Symptoms may take 6 weeks to resolve

References:
1. Hess et al. "Esophagus, Stomach, Duodenum." Rosen's Emergency Medicine, 8e. Chapter 89, Pp 1170-1185. 2014.