But even something as simple as swallowing a pill can cause harm in some cases. This happens when the tablet or capsule gets stuck in the narrow part of the esophagus near the entrance to the stomach and dissolves prematurely, allowing acidic or alkaline substances to come into contact with the unprotected mucous membrane, leading to heartburn, severe pain, and inflammation .
Although drug-induced esophagitis is rare (3.9 cases per 100,000 people annually), mild cases often go unnoticed, meaning the actual incidence may be higher. Because the esophagus lacks the thick protective lining of the stomach, it reacts quickly to aggressive substances. The pain is usually localized, similar to heartburn but more intense. Sometimes the voice may change or swallowing may become painful. In severe, undiagnosed cases, the inflammation can lead to ulcers and serious infections .
Most cases occur in middle-aged women as a result of taking osteoporosis medications, while older adults are more susceptible due to the slower movement of food and medications through the esophagus with age. The risk of complications is higher in individuals with abnormalities in chest anatomy, such as an enlarged heart or thyroid gland, while in children, the cause is often difficulty swallowing or narrowing of the esophagus.
Among the medications that may cause harm are bisphosphonates, tetracyclines, aspirin, and ibuprofen . Additionally, some dietary supplements are not entirely safe. For example, concentrated caffeine increases acidity, vitamin C and L-arginine can irritate the esophagus, and thick potassium chloride tablets or gelatin capsules can stick to the esophageal wall.
However, mild cases usually resolve quickly after stopping the medication. The risk can be significantly reduced by:
Swallow the tablets with a full glass of water.
Take the medication while sitting or standing, and remain in this position for at least 30 minutes , especially when taking it on an empty stomach.
Using alternative forms of medication such as injections or mucosal protectors in cases of long-term treatment.
Divide large disks into parts if possible.
Experts stress the importance of not ignoring any new discomfort, as a simple change in habits can make taking medication safer and protect the esophagus from damage.