Supplement and medication use is common. Most of the time, the pills we swallow make it to the stomach uneventfully. Sometimes, however, there can be a problem. Pill-induced esophagitis is a surprisingly common problem that occurs when caustic medications or supplements damage/irritate the esophagus as they make their way down to the stomach. It is important to be aware of this condition because it is highly preventable. By knowing the top offending supplements and medications, you can take steps to avoid this issue.
Causes
Both medications and supplements can cause pill induced esophagitis. The one thing that all the products have in common is that they contain an active ingredient that is irritating to the esophageal lining.
Commonly triggering medications include:
- Bisphosphonates such as alendronate (Fosamax) and ibandronate (Boniva), given for osteoporosis.
- Tetracyclines, particularly doxycycline – an antibiotic often used for long periods of time to treat acne.
- Iron
- Potassium chloride (KCL)
Commonly triggering supplements include:
- Vitamin C
- Betaine HCL (this is acid given as a digestive support in cases of hypochlorhydria (low stomach acid)
Acute signs and symptoms that could indicate pill induced esophagitis:
- Painful swallowing.
- Difficulty swallowing – You may feel like food is stuck in their throat or that certain types of foods are simply easier to swallow (i.e. liquids or soft food versus solids or dry food).
- Chest pain which is often burning.
- New heartburn or reflux.
Prevention
Awareness of pill induced esophagitis is the key to prevention.
1. Know if you are taking any supplements or medications that are high risk for causing pill induced esophagitis. If you are, be extra careful with how and when you take that product. For combination products, check the ingredients for high levels of vitamin C for example.
2. Whenever possible, take the high-risk medications and supplements in the morning or at a time when you will not be lying down after taking them. So, for example, taking a high dose of vitamin c, iron, or a medication like doxycycline or Fosamax at bedtime right before lying down would be a very bad idea.
3. Take all supplements with a lot of liquid (or food if not contraindicated).
4. If you are a caregiver or family member of an older person who uses supplements and may have visual or cognitive impairment, it is very important that their supplement use is supervised to prevent complications.
5. Lastly, in people with swallowing issues, such as post stroke or any neurologic condition affecting swallowing, the high-risk medications and supplements should be used with extreme caution, as risk of pill induced esophagitis is higher than in the general population.
Take Home Message
Pill induced esophagitis is not a rare condition. The damage that can result from certain high risk (i.e. irritating) medications and supplements can lead to narrowing of the esophagus (a stricture). The result can be chronic swallowing issues which are largely preventable. If your medication or supplement list includes any of the high-risk medications mentioned above, be sure to take precautions to prevent potential long-term complications of pill induced esophagitis.
If you have additional questions, don’t hesitate to reach out for a consultation.
The information provided on this site www.drsharongoldberg.com is for informational purposes only. Dr. Sharon Goldberg and Glow Health, PA assume no responsibility and make no claims in treatment or cure of any disease or illness. The information provided by www.drsharongoldberg.com is not intended to substitute for medical advice from your physician or healthcare professional and is intended to support, not replace, the relationship that exists between a patient/site visitor and his/her physician. If you have/suspect you might have a health problem, you should consult your medical doctor. Supplements can interact with prescription medications. Be sure to consult with a healthcare professional before starting any diet, exercise, or supplement.
