Drug-Induced Esophagitis: Symptoms, Treatment, and Recovery

Drug-induced esophagitis

Hello, Doctor.
Last Thursday night (the 18th), I took the antibiotic doxycycline, drank very little water, and went to sleep immediately.
I woke up in the middle of the night with a burning sensation in my esophagus and difficulty breathing, which lasted for about two hours before the symptoms eased.
However, I have since been experiencing a stabbing pain in my esophagus, difficulty swallowing, and trouble eating, with symptoms gradually worsening.
On Monday (the 22nd), I visited a general practitioner who diagnosed me with medication-induced esophagitis.
The doctor indicated that since there was no bleeding or esophageal perforation, I did not need to be hospitalized immediately.
I was prescribed medication for three days (stomach medication and anti-inflammatory drugs) and advised to only consume cold and room temperature liquid foods.
Since my symptoms have not improved, and I still feel pain even when drinking water, I would like to ask the doctor: How long does the healing period for esophagitis typically take? Can the stomach medication and anti-inflammatory drugs be taken long-term? Under what circumstances should I go to the hospital? Will surgery be necessary? Thank you!

Niming, 20~29 year old female. Ask Date: 2021/02/25

Dr. Chen Shidian reply Gastroenterology and Hepatology

After undergoing gastroscopy, it is confirmed to take mucosal protectants and consume only cold or lukewarm semi-solid foods.
Improvement and recovery should be expected within 3 to 5 days.

Reply Date: 2021/02/25

More Info

Drug-induced esophagitis is a condition that can occur when certain medications, particularly oral medications, irritate the esophagus. This can happen if the medication is not taken with enough water or if the person lies down shortly after taking the medication, which can cause the pill to remain in contact with the esophageal lining for an extended period. In your case, taking doxycycline with insufficient water and then lying down likely contributed to the irritation and subsequent symptoms you experienced.

Symptoms of Drug-Induced Esophagitis
The symptoms of drug-induced esophagitis can vary but often include:
1. Pain or discomfort in the chest: This can feel like a burning sensation or sharp pain, particularly when swallowing.

2. Dysphagia (difficulty swallowing): Patients may feel like food is stuck in their throat or chest.

3. Odynophagia (painful swallowing): Pain may occur when swallowing food or liquids.

4. Nausea or vomiting: Some individuals may experience gastrointestinal upset.

5. Sore throat: Irritation can extend to the throat, causing discomfort.

In your case, the burning sensation and difficulty swallowing are classic signs of this condition.

Treatment and Recovery
The treatment for drug-induced esophagitis typically involves:
1. Medications: As prescribed by your doctor, these may include proton pump inhibitors (PPIs) or H2 blockers to reduce stomach acid and promote healing. Anti-inflammatory medications may also be prescribed to reduce inflammation in the esophagus.

2. Dietary modifications: It is crucial to consume soft, non-irritating foods. Cold or room temperature liquids and foods are often recommended to minimize discomfort. Avoiding spicy, acidic, or hard foods can help prevent further irritation.

3. Hydration: Ensuring adequate fluid intake when taking medications is essential to prevent pills from becoming lodged in the esophagus.

Recovery Time
The recovery time for drug-induced esophagitis can vary depending on the severity of the condition and adherence to treatment. Generally, symptoms may improve within a few days to a week with appropriate treatment. However, complete healing of the esophagus may take longer, sometimes several weeks. If symptoms persist despite treatment, further evaluation may be necessary.

Long-term Use of Medications
Regarding the long-term use of gastric medications, it is essential to follow your doctor's guidance. While PPIs and H2 blockers can be effective for managing symptoms, they are typically not intended for indefinite use without monitoring due to potential side effects. Discuss any concerns about long-term medication use with your healthcare provider.

When to Seek Further Medical Attention
You should seek immediate medical attention if you experience:
- Severe chest pain: This could indicate a more serious condition.

- Signs of bleeding: Such as vomiting blood or having black, tarry stools.

- Persistent symptoms: If your symptoms do not improve or worsen despite treatment.

- Difficulty breathing: This could indicate a more severe reaction or complication.

Surgical Intervention
Surgery is rarely required for drug-induced esophagitis unless there are complications such as strictures (narrowing of the esophagus) or severe damage that does not respond to medical treatment. Most cases can be managed effectively with conservative measures.

In summary, drug-induced esophagitis is a manageable condition with proper treatment and dietary adjustments. It is crucial to follow your healthcare provider's recommendations and to communicate any ongoing or worsening symptoms. If you have any concerns about your treatment plan or recovery, do not hesitate to reach out to your healthcare provider for further guidance.

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