Management of a Pill Stuck in the Esophagus
If you have a pill stuck in your esophagus, drink plenty of water (at least 8 ounces) immediately while sitting or standing upright, and eat soft bread or a banana to help push the pill down. This approach should be attempted first for any pill that feels lodged in the esophagus 1.
Immediate Actions Based on Severity
For Mild Symptoms (Feeling of Something Stuck):
- Drink at least 8 ounces of water while sitting or standing completely upright
- Eat soft bread or a banana to help push the pill down
- Avoid lying down for at least 30 minutes after taking pills
- If discomfort persists for more than 2 hours, seek medical attention
For Moderate to Severe Symptoms:
- Urgent medical attention is required if you experience:
- Inability to swallow saliva (complete obstruction)
- Severe chest pain
- Difficulty breathing
- Drooling
- Vomiting
Medical Intervention
If the pill remains stuck despite the above measures:
- Complete obstruction (inability to swallow saliva): Requires emergent endoscopy within 2-6 hours 1
- Partial obstruction: Requires urgent endoscopy within 24 hours 1
During endoscopy:
- Flexible endoscopy under appropriate anesthesia is the first-line approach
- General anesthesia with endotracheal intubation may be required to protect the airway 1
- The "push technique" (gently pushing the object into the stomach) has a success rate of up to 90% 2
- If pushing is unsuccessful, retrieval techniques using baskets, snares, or grasping forceps will be employed 2
Risk Factors and Prevention
Pills commonly get stuck in the esophagus due to:
- Taking medications with insufficient water 3, 4
- Taking pills while lying down 3, 4
- Pre-existing esophageal conditions (found in up to 25% of cases) 1
- Eosinophilic esophagitis (most common cause of food/pill obstruction)
- Esophageal stricture
- Hiatus hernia
- Esophageal web or Schatzki ring
- Achalasia
- Tumors
Prevention strategies:
- Always take pills with at least 8 ounces (240 mL) of water
- Remain upright for at least 30 minutes after taking pills
- Avoid taking medications immediately before bedtime
- Consider liquid formulations if you have swallowing difficulties
- Take one pill at a time if taking multiple medications
Complications and Follow-up
Pill-induced esophageal injury can cause:
- Odynophagia (painful swallowing)
- Retrosternal pain
- Dysphagia (difficulty swallowing)
- Esophageal ulceration 5, 3, 4
Certain medications are more likely to cause esophageal injury:
- Antibiotics (particularly doxycycline and tetracycline)
- NSAIDs
- Potassium chloride
- Ferrous sulfate
- Bisphosphonates 6, 4
If you've experienced a pill getting stuck, follow-up care should include:
- Evaluation for underlying esophageal disorders
- Consideration of proton pump inhibitors to reduce acid damage
- Dietary modifications if needed
- Possible endoscopy if symptoms persist or recur
Special Considerations
- Capsules are more likely to cause esophageal injury than tablets 4
- Children and elderly patients are at higher risk for pill-induced esophagitis 7
- Even healthy individuals can experience pill entrapment despite taking pills with water while upright 5
Remember that prevention is key - always take medications with plenty of water while sitting or standing upright, and remain upright for at least 30 minutes afterward.