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Dysphagia – Pill Induced Esophageal Injury
Pill-induced Esophageal injury may present as erosions, kissing ulcers, and multiple small areas of ulceration with bleeding, mainly in the middle third of the esophagus.
I never knew that pill-induced esophageal injury was even a thing. I am a cancer survivor who developed a long-term side effect called dysphagia. Local radiation to my neck (C5) has caused my neck muscles to weaken.
I get food caught in my throat occasionally, I get hoarse easily and I can’t sing anymore. I was never much good at singing but it was fun.
As a result I worry about GERD, Barrett’s Esophagus and even esophageal cancer forming in my throat. I believe that I am prone to these health problems because of the weakening of the sphincter at the bottom of my throat just above my stomach.
I came upon the article linked below about pill-induced esophageal injury by accident. Truth be told, I think dysphagia predisposes the person to this health problem.
In other words, if you have dysphagia, I think you are prone to also developing pill-induced esophageal injury.
This post then, is focused on not only highlighting a health problem, but then providing a potential solution to that problem.
If you have dysphagia, swallowing foods, pills, all solids, can become a problem aka get stuck in your throat. I work daily to exercise my throat muscles in an effort to reduce this risk. As I mentioned above, foods, and even pills/capsules, can get stuck in my throat. But I can always dislodge whatever gets stuck.
I’m pretty sure that my neck exercises allow me to un-clog my throat.
If you have dysphagia as well, I recommend doing shaker exercises, daily, as well.
Did you undergo local radiation to your neck? When? How is your ability to swallow? Scroll down the page and let me know.
Thanks,
David Emerson
- Cancer Survivor
- Cancer Coach
- Director PeopleBeatingCancer
Recommended Reading:
- I have Barrett’s Esophagus- what are my options?
- Barrett’s Esophagus- Diagnosis, Prognosis and Treatment
- Ask the Cancer Coach-“Stage 4 esophageal cancer diagnosis and treatment”
Esophagitis
“Esophagitis, also spelled oesophagitis, is a disease characterized by inflammation of the esophagus. The esophagus is a tube composed of a mucosal lining, and longitudinal and circular smooth muscle fibers. It connects the pharynx to the stomach; swallowed food and liquids normally pass through it.[1]
Esophagitis can be asymptomatic; or can cause epigastric and/or substernal burning pain, especially when lying down or straining; and can make swallowing difficult (dysphagia). The most common cause of esophagitis is the reverse flow of acid from the stomach into the lower esophagus: gastroesophageal reflux disease (GERD).[2]”
Pill-Induced Esophageal Injury: Endoscopic Features and Clinical Outcomes
“Pill-induced esophageal injury is a common but under-reported problem. The purpose of this study was to explore the clinical and endoscopic features, and the outcome of pill-related esophageal injury.
Endoscopy records for the period from January 1997 to June 2003 were searched for reports of esophageal pathology. The records of patients with pill-induced esophageal injury were evaluated.
A total of 92 patients with pill-induced esophageal injury were identified (33 men, 59 women; mean age 59, range 25-87).
Common symptoms were:
- odynophagia (n = 69, 75 %),
- chest pain (n = 55, 60 %),
- vomiting (n = 53, 58 %),
- dysphagia (n = 31, 33 %),
- and hematemesis (n = 14, 15 %).
The endoscopic findings in the esophagus were:
- erythema in 76 patients (83 %),
- erosions in 53 patients (58 %),
- ulcers in 24 patients (26 %), seven of which were “kissing” ulcers,
- esophageal ulcer with bleeding in 17 patients (18 %),
- and esophageal strictures in seven patients (8 %).
The causative pills were nonsteroidal anti-inflammatory drugs in 38 patients (41 %), tetracyclines in 20 patients (22 %), potassium chloride tablets in nine patients (10 %), alendronate in eight patients (9 %), and other drugs in 17 patients (18 %).
Underlying diseases included diabetes in 60 patients (65 %), ischemic heart disease in 39 patients (42 %), and hypothyroidism in four patients (4 %).
The mean hospital stay was 1.94 days; 14 patients (15 %) required injection of epinephrine 1 : 10,000 to control bleeding; and two patients died.
Pill-induced injury may present as erosions, kissing ulcers, and multiple small areas of ulceration with bleeding, mainly in the middle third of the esophagus. Advanced age, female gender, diabetes, and ischemic heart disease were common associations. The majority of patients made an uneventful recovery.
Pill-induced esophageal injury
“We report four cases of esophageal injury associated with the ingestion of commonly prescribed tablets or capsules. History and clinical characteristics of these cases suggest that the medications failed to transit the esophagus and acted locally to produce esophagitis.
A search of English- and foreign-language medical journals documented 221 similar cases due to 26 different types of medication.
While most of these esophageal injuries are self-limited and produce no morbidity beyond transient retrosternal pain, odynophagia, and dysphagia, major complications have occurred, such as mediastinal penetration, hemorrhage, and death.
Patients should be counseled to take pills in an upright posture with liberal amounts of fluid well before retiring for the night.
Large Multivitamin, Calcium Pills Can Be a Choking Hazard for Older Adults
“Approximately 19% of adverse events associated with dietary supplements involve swallowing problems, especially choking, and this is mostly likely to occur in adults age 65 or older, according to a new report published in the Annals of Internal Medicine.
The researchers examined adverse events submitted to the FDA Center for Food Safety and Applied Nutrition Adverse Event Reporting System (CAERS) over a 10-year period, from 2006 to 2015. Choking was the most frequently reported swallowing problem (86.0%), followed by foreign body trauma (7.8%). Three deaths attributed to supplement-induced airway obstruction or aspiration were reported.
Most incidents involved multivitamins (72.9%) or calcium supplements (17.3%), both of which are commonly sold in large pill sizes, followed by supplements for pain or arthritis relief (2.3%). A single multivitamin product marketed to older women was involved in 40.6% of swallowing problem reports. The average pill size of supplements associated with swallowing difficulty or choking was 19.3 mm — longer than the FDA’s recommended limit of 17 mm for generic drug pills, and close to its limit of 22 mm for all drug tablets and capsules. Currently there are no similar FDA guidelines for dietary supplement pills.
The researchers suggested decreasing the dosage size or adding pill coatings might help to address the problem, and advised that consumers speak with their pharmacists or physicians about ways to address swallowing difficulties. Drinking ample water when swallowing pills can also help…”