Medications can induce esophageal abnormalities via both systemic effects and by causing direct esophageal mucosal injury. Systemic effects of medications that can result in esophagitis include gastroesophageal reflux and medication-induced infectious complications.
This topic will review medication-induced esophagitis from direct esophageal mucosal injury. The pathophysiology of reflux esophagitis and the clinical manifestations, diagnosis, and management of other causes of esophagitis are discussed in detail, separately. (See "Pathophysiology of reflux esophagitis" and "Pathogenesis, clinical manifestations, and diagnosis of eosinophilic esophagitis" and "Overview of dysphagia in adults".)
The estimated incidence of medication-induced esophagitis is 3.9 per 100,000 population per year with a mean age at diagnosis of 41.5 years [1,2]. Although medication-induced esophagitis has a higher prevalence in women, this may be due to a higher likelihood of women being treated with culprit medications rather than an underlying difference in susceptibility to medication-induced esophageal injury. Medication-induced esophagitis usually occurs at anatomical sites of esophageal narrowing. Of these, the most common site is near the level of the aortic arch (76 percent) due to extrinsic compression and physiologic reduction in the amplitude of the esophageal peristaltic wave .
Medications that cause direct esophageal mucosal injury include the following.
Antibiotics — Tetracycline, doxycycline, and clindamycin have been associated with esophagitis due to their direct irritant effect. (See 'Pathogenesis' below.)