Tetracyclines, NSAIDs, bisphosphonates, potassium chloride, and iron supplements can cause which condition?

• A. Medication-induced esophagitis
• B. Peptic ulcer disease
• C. GERD
• D. Esophagitis from smoking

Answer: (A)

Pill-induced esophagitis occurs when certain oral medications irritate or injure the esophageal mucosa if the pill lingers in the esophagus. Tetracyclines, NSAIDs, bisphosphonates, potassium chloride tablets, and iron supplements are classic culprits because they are relatively caustic to mucosa and can get stuck or dissolve where contact is prolonged. The injury presents with odynophagia and chest pain and can mimic reflux, but it’s specifically caused by the pill’s local mucosal damage rather than general acid exposure.

This differs from peptic ulcer disease or GERD, where the primary problem is acid injury to the stomach or distal esophagus from reflux, not a localized reaction to a swallowed pill. Smoking-related esophagitis isn’t a recognized standard cause of a discrete pill-induced injury, though smoking can worsen reflux symptoms in general. To prevent this, pills should be taken with plenty of water and the patient should stay upright for at least 30 minutes after taking them. If symptoms occur, stopping the offending medication and evaluating with endoscopy if needed are typical steps.