[When pills attack : a closer look at drug-induced esophagitis]

Drug-induced esophagitis is a rare but likely underreported complication of many prescribed oral medications (most commonly nonsteroidal anti-inflammatory drugs and antibiotics). Pathophysiological mechanisms include direct caustic mucosal injury, increased gastric reflux, reduced mucosal protection, or infection. Some risk factors are modifiable, such as inadequate fluid intake, supine posture after ingestion, and large or gelatin-coated tablets, but others are linked to underlying conditions such as esophageal motility disorders, strictures, or extrinsic compression. Diagnosis relies on history; endoscopy is reserved for severe or atypical symptoms. Management is mainly conservative with temporary cessation of the causative drug. Selecting an appropriate medication and following the package insert can reduce the overall risk.