Every year, people take billions of doses of medicine orally, but pills can sometimes cause harm. Pill-induced oesophagitis occurs when a tablet or capsule gets stuck in the narrowing at the lower end of the oesophagus, releasing its active ingredients directly onto delicate tissue and causing a chemical burn.
Studies estimate an incidence of 3.9 per 100,000 population per year, though mild cases often resolve without medical attention. Symptoms include sharp, localised pain behind the breastbone, pain when swallowing, or sudden hoarseness. In rare untreated cases, ulcers can rupture through the oesophageal wall, leading to severe infection or death.
Middle-aged women are most often affected, partly because they are more likely to take regular medication such as bisphosphonates for osteoporosis. Older adults are at higher risk due to age-related changes in oesophageal motility, as are people with conditions that alter nearby organs. Children have unique risk factors including difficulty swallowing pills and smaller anatomy.
Known culprits include bisphosphonates, tetracycline antibiotics, aspirin, and ibuprofen. Over-the-counter supplements such as caffeine tablets, potassium chloride, L-arginine, and high-dose vitamin C or vitamin E have also been linked. Gelatine-based soft capsules can become sticky and cling to the oesophageal wall, causing local irritation.
