What is the treatment for pill esophagitis?

Treatment for Pill Esophagitis

The primary treatment for pill esophagitis is immediate discontinuation of the offending medication and supportive care with proton pump inhibitors (PPIs) administered twice daily for 8-12 weeks. 1

Immediate Management

1. Discontinue the causative medication

   • Identify and stop the offending pill/capsule immediately 2, 3
   • Common culprits include doxycycline, tetracyclines, NSAIDs, bisphosphonates, and certain supplements 2, 4, 5

2. Supportive care

   • Intravenous fluid support for patients with severe dysphagia 2
   • Liquid diet until symptoms improve
   • Pain management for odynophagia and retrosternal pain

3. Acid suppression therapy

   • First-line: Proton pump inhibitors (PPIs)
     • Omeprazole 20-40mg twice daily for 8-12 weeks 1, 6
     • Helps reduce acid exposure to the injured esophageal mucosa
     • Promotes healing of esophageal erosions 7

Follow-up Care

• Most patients improve within 2-7 days after discontinuing the offending medication 2
• Complete healing typically occurs within 3-4 weeks 2
• Repeat endoscopy may be considered in severe cases to confirm healing

Prevention Strategies

To prevent recurrence, patients should be educated to:

• Take pills with at least 180-240ml (6-8oz) of water 4, 3
• Remain in an upright position for at least 30 minutes after taking pills 4
• Never take medications immediately before bedtime 2, 3
• Consider alternative formulations (liquid, chewable) for medications known to cause esophagitis

Special Considerations

• For patients with persistent symptoms despite appropriate management, consider:

  • Endoscopic evaluation to rule out other causes of esophagitis
  • Evaluation for underlying esophageal motility disorders
  • Assessment for anatomical abnormalities that may predispose to pill retention

• Patients with severe cases may require:

  • Temporary parenteral nutrition if unable to maintain adequate oral intake
  • Hospitalization for severe cases with significant pain or dehydration

Common Pitfalls

• Failing to recognize pill esophagitis as the cause of acute chest pain and dysphagia
• Continuing the offending medication despite symptoms
• Inadequate patient education about proper pill-taking techniques
• Insufficient duration of acid suppression therapy
• Overlooking dietary supplements as potential causes of pill esophagitis 5

Most cases of pill esophagitis resolve completely with conservative management and discontinuation of the offending agent. Complications such as strictures are rare but may occur in severe or untreated cases.