Pill Esophagitis

Abstract

Nine hundred seventy-nine cases of pill esophagitis due to nearly 100 different medications are reviewed. Pill-induced injuries occur when caustic medicinal pills dissolve in the esophagus rather than passing rapidly into the stomach as intended. Most patients suffer only self-limited pain, but esophageal hemorrhage, stricture, and perforation may occur, and fatal injuries have been reported. The incidence of this iatrogenic injury can be reduced but not eliminated by emphasizing the importance of taking pills while upright and with plenty of fluids.

Learning From History: How to Swallow a Pill

“…This condition is known as pill-induced esophagitis or just pill esophagitis, an underreported condition that is well known to gastroenterologists and underrecognized by other medical specialists. [8][9][10] Patients who experience pill esophagitis commonly only suffer sudden-onset retrosternal pain. Although this pain is usually self-limiting, it can persist for several days in association with dysphagia.…”

“…In some cases, esophageal hemorrhage, stricture, and perforation may occur, and fatality is a rare but possible outcome. [8][9][10] Iron-containing medications have long been known to cause pill esophagitis. Initiation or exacerbation of esophageal and gastric lesions by iron has been histologically demonstrated, 11,12 and fatality has been reported.…”

“…[8][9][10]14 In psychiatry, pill esophagitis has been reported with fluoxetine. 15 In fact, a large review 8 described pill esophagitis in association with nearly a hundred different medications in 979 patients. The management of pill esophagitis was summarized by Kikendall.…”

Histomorphological and immunophenotypic features of pill-induced esophagitis

“…Some authors summarized the case reports in medical literature [5] or reviewed features of pill-induced esophagitis [3,8]. Additionally, some review articles described the medication-associated damage on gastrointestinal tract, including the esophagus [2,[9][10][11][12][13]. However, histopathological features of pill-induced esophagitis have only been described as nonspecific ulcer [13] or intraepithelial eosinophilic infiltration [14].…”

Ulceración esofágica extensa por toma de doxiciclina

“…También se ha propuesto que la acumulación del medicamento en la capa basal del epitelio provoca inhibición de la síntesis proteica (3). La presentación clínica habitual es dolor retroesternal, odinofagia y disfagia, de aparición aguda, entre las primeras horas y hasta 10 días después del inicio de la toma del fármaco (1,3). La localización más frecuente es la unión entre el tercio superior y medio esofágico, debido a la compresión fisiológica del arco aórtico.…”