Sometimes it’s hard to go with the flow.
While oral medications are generally considered safer and more convenient than injections or inhalations, sometimes a simple swallow is easier said than done.
Pill-induced esophagitis goes down, literally, when a tablet or capsule gets stuck in the narrowing of the esophagus, particularly where it meets the stomach.
“Although considered uncommon, studies suggest it has an estimated incidence of 3.9 per 100,000 population per year,” Adam Taylor, professor of anatomy at Lancaster University in the UK, wrote last week in The Conversation.
“It may be under-reported because mild cases often resolve without medical attention.”
The esophagus is lined with a special mucosal layer that helps ferry food to the stomach. When a pill dissolves before it reaches that tough container, it exposes the vulnerable esophageal lining to caustic substances that it cannot defend against.
As the lodged pill begins to unravel, it can release its active ingredients onto this tender tissue, causing pain, inflammation and even ulceration.
Symptoms may feel like heartburn, indigestion or a sharp pain behind the breastbone.
Additional symptoms include pain when swallowing and/or a sudden change in vocal tone.
For most, symptoms resolve within a few days or weeks of stopping the medication.
In rare and untreated cases, the damage can intensify, leading to ruptured ulcers in the esophageal wall that can cause infection and even death.
Middle-aged women have the highest risk for pill-induced esophagitis, as they are statistically more likely to take oral medication often.
Older adults are increasingly vulnerable, as age-related changes in esophageal mobility can make it challenging for pills to reach the stomach without interruption.
Those with an enlarged heart or thyroid are also at greater risk, as these conditions can alter the shape of nearby organs and make swallowing difficult.
While any pill can cause esophagitis, certain medications are more likely than others to irritate or injure.
Top esophagitis offenders include bisphosphonates, the most commonly prescribed osteoporosis treatment.
Osteoporosis disproportionately affects women, which may explain why more women than men experience pill-induced esophagitis.
Other risky pills include tetracycline antibiotics, used to fight an array of infections. Aspirin and ibuprofen can also induce esophagitis, though these medicines disrupt rather than directly burn the esophagus.
In addition, potassium chloride supplements can irritate the esophagus because they are large and dense.
L-arginine, caffeine tablets and high-dose vitamin C or vitamin E pills may also present problems.
Experts warn that the gelatin in gel capsules is hygroscopic, or moisture-absorbing, and can easily stick to the esophageal wall.
Doctors may recommend a different formulation or an injectable version of certain medicines.
Blessedly, there are simple steps that can prevent esophagitis. Start by taking pills with a full glass of water and as prescribed.
If the drug requires an empty stomach, follow directions and stay upright for at least 30 minutes.
This prevents regurgitation and gives the medication ample time to dilute in the stomach.
To reduce the risk of esophagitis with multiple medications, swallow each pill one at a time and/or use a pill cutter to make larger tablets smaller.
Seek medical attention if you experience persistent pain or difficulty swallowing.
To treat esophagitis, proton pump inhibitors can reduce stomach acid and support healing, while sucralfate, used for stomach ulcers, can form a protective barrier over irritated tissue.
