What should I do if I have a persistent sore throat and feel like a pill is stuck in my esophagus for three days?

Immediate Endoscopic Evaluation Required for Persistent Esophageal Symptoms

You need urgent endoscopy within 24 hours to evaluate for a retained pill or pill-induced esophageal injury, as persistent symptoms for three days indicate either a persistent foreign body or significant mucosal damage that requires direct visualization. 1

Why This Requires Urgent Action

The three-day duration of persistent throat pain and foreign body sensation is clinically significant and warrants intervention:

• Therapeutic flexible endoscopy is the first-line treatment for persistent esophageal foreign bodies and should be performed urgently (within 24 hours) for esophageal foreign bodies without complete obstruction 1
• Endoscopic evaluation should be performed even if radiographic examination is negative when patients have persistent esophageal symptoms 1
• The sensation of a pill being "stuck" combined with persistent, worsening sore throat for three days suggests either retained medication or pill-induced esophagitis requiring direct assessment 1

Diagnostic Workup Before Endoscopy

Imaging Studies

• Plain radiographs (neck, chest, abdomen) have limited utility here - they detect only 53% of esophageal foreign bodies and miss up to 85% of pills and medication fragments 1, 2
• CT scan should be performed if there is any suspicion of perforation or complications (fever, severe chest pain, difficulty swallowing saliva, breathing difficulty) - CT has 90-100% sensitivity for detecting foreign bodies and complications 1, 2

Laboratory Tests

If proceeding to endoscopy, obtain:

• Complete blood count (CBC) 1
• C-reactive protein (CRP) 1
• Blood gas analysis for base excess and lactate 1

Red Flags Requiring Emergency Evaluation (Within 2-6 Hours)

Watch for these complications that would escalate urgency:

• Complete inability to swallow saliva - indicates complete esophageal obstruction requiring emergent endoscopy 1
• Fever, persistent chest pain, breathlessness, or tachycardia - suggests possible perforation requiring immediate CT scan with oral contrast 1
• Worsening symptoms despite conservative management - indicates need for immediate intervention 1

What Endoscopy Will Accomplish

The endoscopy serves multiple purposes:

• Direct visualization to identify retained pill fragments or food bolus 1
• Assessment of mucosal injury - pills can cause chemical burns, ulceration, or stricture formation even after passing 1
• Therapeutic intervention - gentle pushing of any retained material into the stomach or retrieval if necessary 1
• Diagnostic work-up for underlying esophageal pathology that may have predisposed to pill retention (stricture, motility disorder, anatomic abnormality) 1

Common Pitfall to Avoid

Do not delay endoscopy waiting for symptoms to resolve spontaneously - while 80-90% of ingested foreign bodies pass spontaneously, the three-day persistence of symptoms indicates this is not happening, and continued delay risks complications including perforation, stricture formation, or deeper mucosal injury 1

Immediate Symptomatic Management While Arranging Endoscopy

Until endoscopy can be performed:

• Maintain NPO (nothing by mouth) except small sips of water if complete obstruction is suspected 1
• Avoid attempting to force swallowing or induce vomiting - this increases perforation risk 1
• Do not use oral contrast studies - these should be avoided as they can coat the foreign body and impair endoscopic visualization, and they increase aspiration risk 1

Post-Endoscopy Considerations

After endoscopy, if pill-induced esophagitis is confirmed:

• Patients typically require acid suppression therapy and dietary modifications 1
• Avoid alcohol, bulky food, spicy or hot foods, citrus products during healing 1
• Follow-up endoscopy may be needed if stricture develops 1