- When a Pill Gets Stuck
- A Tough Pill To Swallow: Medications Can Trigger Acid Reflux Symptoms
- Corrosive Esophagitis
- What is corrosive esophagitis?
- What causes corrosive esophagitis?
- What increases my risk of corrosive esophagitis?
- What are the signs and symptoms of corrosive esophagitis?
- How is corrosive esophagitis diagnosed?
- How is corrosive esophagitis treated?
- What are the risks of corrosive esophagitis?
- What can I do to prevent corrosive esophagitis?
- When should I contact my healthcare provider?
- When should I seek immediate care or call 911?
- Further information
- Learn more about Corrosive Esophagitis
- Summit Medical Group Web Site
When a Pill Gets Stuck
Q1. What should I do if I am taking medication and the pills get stuck? This has happened to me several times. I’m not choking and can still talk, but I can feel the pill moving in my throat when I swallow.
— Hazel, Canada
Pills can get stuck when swallowed and cause significant problems through mechanisms that are not entirely understood. Some compounds, including medications that treat osteoporosis (Fosamax , for example) are very irritating to the esophagus, and people taking these drugs are always instructed to sit upright for at least 30 minutes after taking the dose. This is because the medication can cause a problem known as esophagitis — inflammation of the esophagus that can lead to serious complications, including pain and bleeding. This problem requires two factors: a pill or capsule getting lodged in the esophagus, leading to a prolonged period of contact, and a compound that is either too acidic or basic for the esophagus. Other medications that can cause direct irritation to the esophagus include anti-inflammatory agents such as ibuprofen, tetracycline antibiotics, iron, and potassium.
To avoid the problem of pills getting stuck, prevention is clearly key. Follow these steps:
- Never take a medication when you are lying down; instead, sit or stand when swallowing a pill.
- Remain upright for at least 30 minutes afterward if possible.
- Drink enough liquid — usually a minimum of eight ounces — when taking pills so that the pill is “chased” down.
Q2. Is it okay to take Ambien CR indefinitely? I have been taking it for about two months now. I tried to stop it the other night, and I was awake most of the night. This has been the only sleep aid that has allowed me to sleep through constant abdominal pain that I am currently having treated. But I am worried about Ambien’s long-term effects. Do you have any advice?
— Lori, Colorado
Unfortunately, it is not acceptable to take Ambien CR (zolpidem tartrate extended release) indefinitely, because long-term use of the drug can lead to dependency.
The product labeling for Ambien CR approved by the Food and Drug Administration and a March 2007 Dear Health Care Professional letter from Ambien’s manufacturer, Sanofi-aventis, indicate that if insomnia doesn’t get better after the drug is taken for 7 to 10 days, an underlying medical problem may be involved. (“Dear Health Care Professional” letters are provided by drug manufacturers to health care professionals. They detail the latest drug safety information and prescribing instructions and include any discussions or reviews by the FDA.)
From what you describe, your abdominal pain is disrupting your sleep, which concerns me. Although you don’t indicate what caused your abdominal pain or how it is being treated, I suggest that you reevaluate the use of Ambien CR as a sleep aid with your physician. (Please be sure to inform all the physicians involved in your current care plan in this evaluation, if in fact you are being cared for by more than one physician.)
Here’s something else to keep in mind: Consuming large amounts of caffeine can also affect your sleep. The caffeine in coffee, tea, and other caffeinated drinks can add up quickly. If it’s possible that this is contributing to your sleeping problem, I suggest stopping caffeine or switching to noncaffeinated drinks after 10 or 11 a.m.
Symptoms of esophagitis vary depending on the cause of the inflammation. The most common sign is heartburn (a burning sensation under the breastbone that may move up to the throat). If the inflammation is severe, swallowing may be painful.
Causes and Risk Factors of Esophagitis
Several factors can cause esophagitis, including:
- Gastroesphageal reflux disease (GERD). The most common risk factor for esophagitis, GERD causes acid and partially digested food to flow from the stomach back up the esophagus, irritating the lining.
- Infections caused by fungus, bacteria or viruses. These occur most often in people whose immune systems are not working well.
- Pills. Esophagitis can result when a swallowed pill gets stuck in the throat and burns the lining, usually when not enough liquid was used to wash down the pill. It may also occur if the esophagus does not contract properly or is narrowed because of a scar.
- Injury from chemicals. When a strong chemical (e.g., drain cleaner or household cleaner) is swallowed. This can be very severe, even life threatening.
G&H Is there a particular group of patients who are at high risk for pill-induced esophagitis?
JWK Most patients who develop pill-induced esophagitis are receiving antibiotics for any number of common conditions, including urinary tract infections and strep throat. I believe that elderly patients are more likely, given the same medications, to develop pill-induced esophagitis than younger patients. Patients with cardiomegaly with left atrial enlargement seem predisposed to the condition because the left atrium can compress the esophagus. Those who have esophageal motility disorders of any sort seem to be predisposed, although this is not entirely clear in the case reports in the literature.
The quantity of pills taken has not been correlated with esophagitis. The likelihood of injury has more to do with the specific pills that are taken and the posture in which the patient habitually takes them, as well as whether or not they take a significant amount of water with them. The contents of certain pills are simply more caustic. A lot of the antibiotics are inherently injurious if they remain in contact with the mucosa. On the other hand, therapies with heavy pill burden, such as mesalamine formulations for inflammatory bowel disease, do not necessarily relate to pill-induced esophagitis because they do not have the same caustic properties.
Patients should be reminded that any pill, particularly the more caustic pills that have been frequently reported to cause this type of injury, should be taken upright, with a full glass of water, and not immediately prior to going to bed. This is in contrast to the way pills are often given to sick people, where the patient is in bed, props up on one elbow, takes the pill, and then goes right back to sleep. This scenario is designed to cause problems, and patients who are already ill do not need any extra problems.
G&H Can you describe the typical symptoms and presentation of a patient with pill-induced esophagitis?
JWK The typical patient takes a pill, perhaps without a lot of water, just as they are going to bed. Two hours later, they develop a rapidly increasing severity of chest pain. This pain may be continuous and is often exacerbated by swallowing. It lasts a few days and gets better gradually. In more severe cases, patients may not be able to eat for a period of time. They may require parenteral fluid support or alimentation. Some cases are complicated by stenosis, hemorrhage, or even perforation. However, this scenario is fairly uncommon.
G&H Can patients with pill-induced esophagitis take other oral medications in order to relieve their symptoms?
JWK If patients can still swallow without too much pain, there is no reason why they cannot take oral medication, although they must be advised to swallow with a full glass of water and to remain in an upright position. How well nonsteroidal anti-inflammatory drugs (NSAIDs) or even narcotics actually relieve pill esophagitis-induced pain has never been defined. Topical pain relievers, such as viscous xylocaine administered in moderation, may bring some relief and have been used with success in some reported cases. Patients have also been treated with anti-secretory agents, antacids, Gaviscon, and sucralfate to reduce exposure of the injured mucosa to refluxed acids.
G&H What are the specific medications most likely to cause pill-induced esophagitis?
JWK Antibiotics account for about half of the reported cases. The list of specific antibiotics is very long and is headed by doxycycline. Doxycycline is formulated as a relatively large capsule, which may partially account for its tendency to cause injury. Fortunately, antibiotics rarely cause any complicated injury.
Conversely, NSAIDs have been reported to cause far fewer injuries, but more of those cases have complications. With antibiotics, a recent tally of reported cases was over 500, but only 7 of these cases were complicated by hemorrhage. In comparison, there have been fewer than 200 total reported cases of NSAID-induced injury, but 22 of those were complicated by hemorrhage.
Many other medications have been reported to cause injury, but the foremost in terms of severity are the bisphosphatases, particularly alendronate (Fosamax, Merck). This pill has caused more strictures than any other oral medication. A recent tally showed 127 cases of pill-induced esophagitis reported in association with this drug, and 26 of those cases were complicated by strictures. If a patient develops an alendronate-related injury, there is an approximate 20% chance of developing a stricture, as reported in the literature. Interestingly, there have not been nearly as many reports of alendronate-induced esophagitis in the last 5 or 6 years as there were during the second half of the 1990s. Reporting bias could explain some of the decline in reported cases, but it is still widely prescribed. There are several other factors that may be playing a role in its reduced frequency of injury. First, I think physicians are aware of the potential causticity of the agent, have emphasized the importance of taking it in the proper fashion, and are avoiding its use in patients with underlying esophageal problems. Further, the manufacturer may have reformulated or redesigned the tablet so that it is less likely to stick in the esophagus.
Some of the other drugs that caused the most severe injuries in the past seem to be of less concern currently as well. Literature from the 1970s and 1980s reported many strictures associated with potassium chloride tablets and with quinidine, but these agents are no longer so frequently administered.
G&H Do patients with pill-induced esophagitis ever develop chronic or recurring symptoms?
JWK It is very unusual for patients to develop chronic symptoms unless they have strictures. Recurrence is also rare. The patients at risk for recurrence are those who cannot take pills with adequate water, cannot swallow a lot of water, cannot sit up to take the pills, or who have structural abnormalities in the esophagus or compressions of the esophagus. Those patients are at high risk and require inventive approaches to avoiding recurrence. Crushing pills would spread them over a large area but would not necessarily avoid the problem of prolonged contact with the mucosa. Alternative, less caustic medications may be an option. Intravenous, sublingual, intrarectal, or subcutaneous formulations may be required to remedy the problem in some patients.
G&H What are the future concerns with regard to treating this patient population?
JWK I think that trends are positive. I currently see this problem less than in the past, and I believe this is due to a number of factors. Physicians have learned to recognize pill-induced esophagitis, so they do not send patients forward to gastroenterologists as much as they once did. Further, injuries are not occurring as frequently because some of the most strongly-associated drugs have either been removed from the market or are used less often. Manufacturers have probably paid some attention to this problem and designed pills that are less likely to cause these complications. Finally, I think patients have been better educated to take their pills properly. For all of these reasons, pill-induced esophagitis is steadily decreasing in incidence.
The views expressed in this article/lecture are those of the author and do not necessarily reflect the officialpolicy or position of the Department of the Navy, Department of Defense, nor the US Government.
A Tough Pill To Swallow:
Medications Can Trigger Acid Reflux Symptoms
Types of drugs that can cause reflux and other problems when lodged in the esophagus include:
- Pain-relieving medications, such as aspirin, ibuprofen (ex. Advil, Motrin) and naproxen (ex. Aleve)
- Antibiotics, such as tetracycline and doxycycline
- Potassium chloride, which is used to treat potassium deficiency
- Bisphosphonates, including alendronate (Fosamax), a treatment for osteoporosis (weak and brittle bones)
While food related triggers can be avoided with sheer willpower, a medication may be essential to treat a disease, relieve pain or fight off an infection. However, anyone taking medication is at risk of an acid reflux attack or other damage if pills are obstructed in the esophagus. Fortunately, there’s a way to take medication to help prevent drug-induced GERD and other esophageal damage.
Tips to help a capsule pass through the esophagus quickly and into the stomach:
- Take several sips of water to wet the throat before taking a tablet or capsule
- Swallow the pill with at least 8 ounces of fluid
- Take medication while in an upright or sitting position
- Stay upright for at least fifteen minutes after taking a pill
Avoid these common mistakes when taking medication:
- Not drinking enough water after swallowing a pill
- Taking medication while lying down
- Lying down immediately afterwards
- Taking medication just before going to bed
This material must not be used for commercial purposes, or in any hospital or medical facility. Failure to comply may result in legal action.
Medically reviewed by Drugs.com. Last updated on Sep 24, 2019.
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- Q & A
What is corrosive esophagitis?
Corrosive esophagitis is a condition where your esophagus is damaged by harmful substances. The esophagus is the tube that connects your mouth to your stomach. The damage may cause inflammation, ulcers, or scarring.
What causes corrosive esophagitis?
- Caustic substances: If swallowed, strong chemicals such as detergents, dishwashing liquid, and drain cleaners cause corrosive esophagitis. Young children may swallow these accidently. Adolescents and adults may swallow them to try to harm themselves.
- Radiation therapy: This procedure uses x-rays to kill cancer cells. Sometimes the x-rays may damage your esophagus.
- Pills: If you have a narrow esophagus, pills can get caught and damage your esophagus. Other pills can irritate your esophagus even if they do not get caught. These include antibiotics, pain medicines, and drugs for osteoporosis (weak bones).
What increases my risk of corrosive esophagitis?
- Increased age: As you get older, it may take longer to digest foods. This may cause food to stay in your esophagus or stomach longer. You may also take more medicine that increases your risk of corrosive esophagitis.
- Medical problems: Certain conditions cause your esophagus to narrow or the muscles not to work correctly. You may also have dry mouth, leading to decreased amounts of saliva. This may cause food to get stuck in your esophagus. Heart problems that cause your heart to get bigger and press on your esophagus can make the opening smaller.
- Not taking pills correctly: Pills may get stuck in your esophagus if you do not drink enough water when you take them.
What are the signs and symptoms of corrosive esophagitis?
- Chest pain that is sudden or happens after you take a pill
- Pain when you swallow liquids or food
- Decreased appetite
- Vomiting blood
How is corrosive esophagitis diagnosed?
Your healthcare provider will ask about your symptoms and other health problems. He may ask what pills you have taken, what treatments you have received, or if you have swallowed any harmful liquids. You may need one or more of the following:
- Barium swallow: This is a test where pictures of your abdomen are taken. You will need to swallow a thick liquid called barium that helps the intestines show up better on x-ray.
- Endoscopy: This is also called an EGD. This procedure helps healthcare providers see the inside of your esophagus and stomach using a flexible tube with a small light and camera on the end. Healthcare providers may remove a small amount of tissue from your esophagus for a biopsy. Your healthcare provider will look for any bleeding, lumps, narrowing, scars, tears, or pill pieces.
How is corrosive esophagitis treated?
Your healthcare provider may have you stop certain medicine or treatments for a period of time. This will give your esophagus time to heal. Do not stop any treatments without talking to your healthcare provider first. You may also need the following:
- Antibiotics: Antibiotics help treat or prevent an infection in your esophagus.
- Steroids: These help decrease inflammation.
- Stomach acid medicine: These help decrease irritation from stomach acids.
- Antiulcer medicine: These help decrease irritation from stomach acids. They may help increase the protective lining of the esophagus to help it heal.
- Dilatation: This is a procedure where a small balloon, dilator, or stent is placed in your esophagus to widen it.
- Surgery: You may need surgery to remove an area of your esophagus. It may be replaced with a portion of your stomach or colon.
What are the risks of corrosive esophagitis?
During surgery, you may bleed more than expected or get an infection. Without treatment, you may continue to feel pain and have trouble swallowing food and liquids. You may not be able to eat enough, and you may lose weight and feel weak. Sometimes, food, liquids, or vomit may get in your lungs. You may choke, get an infection in your lungs, or have trouble breathing. Too much damage in your esophagus can cause bleeding that does not stop. These conditions may be life-threatening.
What can I do to prevent corrosive esophagitis?
- Sit or stand when you take your medicine: Do not lie down after you take your pills. Stay in an upright position for 10 to 15 minutes after you take your pills.
- Store harmful chemicals in a safe location: Label bottles with harmful substances, and keep them out of the reach of children.
- Ask for other ways to take your medicine: If you have a narrow esophagus, ask if you can take your medicine in liquid form. Ask if you can crush the pill and mix it with liquid to drink. If you must swallow pills, take them 1 at a time. Take each one with at least 4 ounces of liquid.
When should I contact my healthcare provider?
- You have a fever.
- You have pain that does not decrease or go away after you take your pain medicine.
- You vomit and cannot keep food or liquids down.
- Your stomach feels very full, and you cannot burp or vomit.
- You have questions or concerns about your condition or care.
When should I seek immediate care or call 911?
- You feel like food or medicine is stuck in your esophagus and it does not go down when you drink water.
- Your vomit has blood in it or looks like coffee grounds.
- You have sudden chest pain and shortness of breath.
- You have black or bloody bowel movements.
- Your symptoms are getting worse.
You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.
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Learn more about Corrosive Esophagitis
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- Allergic Esophagitis
© iStock/steex Most of us at some point have taken a pill without water, either because we were in a rush, too lazy to get up from our desk, or there wasn’t a drink nearby. But here’s why it’s actually quite dangerous—even fatal.
Washing a pill down with water is important not only because it makes swallowing easier, but because it helps prevent the pill from getting stuck in your esophagus, which can cause much more than discomfort.
“Medications that are lodged in the esophagus are very likely to cause inflammation and irritation,” says Jennifer Caudle, DO, a board-certified family medicine physician and assistant professor in the department of Family Medicine at Rowan University-School of Osteopathic Medicine. “This can cause a number of symptoms from heartburn and chest pain to esophagitis, or even bleeding and holes.”
Since there are no pain nerves in parts of the esophagus, symptoms don’t always begin right away, which can make it difficult for you to know if a pill doesn’t make it all the way down. Some people experience chest pain or a feeling similar to heartburn, so they might just dismiss the sensation as a temporary discomfort.
Over time, however, pills that get stuck along their journey can break down and erode the delicate tissue of the esophagus, causing painful bleeding and hemorrhaging, or severe dehydration, all of which can become quite serious.
A study from the Turkish Journal of Gastroenterology found that almost any kind of drug can cause an ulcer in the esophagus, but according to Dr. Caudle, a few common medications can cause significant damage when they get stuck, including drugs to treat osteoporosis, antibiotics, and over-the-counter pain relievers. “Pain relieving medications such as Motrin and Advil are commonly taken without water, and that class of drugs can be notoriously problematic if they get lodged in the throat,” says Caudle.
A surgeon at Morristown Memorial Hospital in New Jersey tells the story of a teenage football player who would pop two Advil with no water before every game—and developed an esophagus that looked “like Swiss cheese” for all the holes the pills had burned. Vitamin C and iron supplements have also been found to be especially problematic.
To avoid dangerous complications when swallowing pills, it’s always best to wash them down with at least eight ounces of water, Caudle advises. She also recommends taking pills standing or sitting up, never lying down. This means you should avoid taking medication right before bed, or at least 15 minutes before bed, to allow the pill time to travel down the esophagus.
“It’s not to say that if you don’t drink anything, your pill will always get stuck,” says Caudle. “But the risk is higher if you don’t have a full glass of water.” Don’t miss the other over-the-counter medication mistakes you’re probably making.
Summit Medical Group Web Site
What is lung aspiration?
Breathing a foreign substance into your airways is called lung, or pulmonary, aspiration. The substance could be food, liquid, medicine, mucus, or saliva.
Aspiration can cause choking. It can also cause a problem called aspiration pneumonia, which is a serious infection in the lungs.
What is the cause?
Normally, any material that is in the back of your throat is swallowed and goes into your esophagus, the tube that leads to your stomach. Your windpipe sits in front of the esophagus and leads to your lungs.
Swallowing is automatic and complex. It is coordinated with breathing to prevent anything in your throat from going down into your lungs. When this coordination is lost, aspiration can occur. Some things that can cause such a problem are:
- Nervous system disorders, such as a stroke or multiple sclerosis
- A defect in some part of the throat or vocal cords
- A breathing disorder, such as chronic obstructive pulmonary disease (COPD)
- Gastroesophageal reflux disease (GERD)
- Medicines or surgery
- Laughing or inhaling when food or fluid is in your mouth
People who cannot cough very well due to a stroke or other nervous system condition are at the highest risk of aspiration.
What are the symptoms?
The main symptom is choking or coughing before or after you swallow. Choking or coughing is the way that your body tries to remove something from the windpipe. Other symptoms can include a shortness of breath or wheezing that comes on quickly.
Many people have what is called a silent aspiration. This means they did not have any cough when they inhaled the foreign substance. It’s a common problem for people who have problems with swallowing.
How is it diagnosed?
You may be referred to a speech language pathologist who will observe how you swallow liquid and solid foods.
Aspiration can be diagnosed by a test called a videofluoroscopic swallowing study or video swallow. This must be done in a hospital radiology (X-ray) department. You are asked to swallow foods in various amounts and degrees of thickness (usually thin liquids, thickened liquids, pudding, and cookies or crackers) while in a sitting position. You may also be asked to swallow barium. An X-ray video is made that helps find where and when you have problems swallowing.
If your healthcare provider suspects that you have aspiration pneumonia, a chest X-ray is usually taken.
How is it treated?
There is no treatment for aspiration itself. Aspiration pneumonia is treated with antibiotic medicine.
How can it be prevented?
Follow these precautions to keep from breathing substances into your airways:
- Don’t talk or laugh when you are drinking or have food in your mouth.
- Limit the amount of food you put in your mouth at one time.
- Avoid foods that you have trouble swallowing. If you have trouble swallowing a medicine, ask your healthcare provider if there is a different form of the medicine that may be easier for you to swallow.
- Follow the therapies recommended for you if you have had a swallowing study.