• Patient who has been taking ibuprofen (NSAIDs) who presents with painful swallowing with no other findings, most concerning for pill-induced esophagitis
• Causes of pill-induced esophagitis: Tetracyclines, Bisphosphonates, potassium chloride, NSAIDs, Iron
• Zenker diverticulum: Older patient with halitosis, regurgitation of food +/- palpable neck mass

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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.)

Anti-inflammatory medications — Aspirin and anti-inflammatory agents can cause severe esophagitis, esophageal strictures, and bleeding [1].

Bisphosphonates — Although the incidence of side effects with bisphosphonates is low if proper administration instructions are followed, esophagitis, esophageal ulcers, and strictures can still occur [3-8]. (See 'Prevention' below.)

Among oral bisphosphonates, risedronate appears to have minimal gastrointestinal toxicity, and, in clinical practice, some patients have fewer gastrointestinal side effects with risedronate as compared with alendronate [6,7]. In an endoscopic study of 515 postmenopausal women receiving daily risedronate or alendronate for two weeks, significantly fewer gastric ulcers were seen in the risedronate group as compared with alendronate (4.1 versus 13.2 percent) [9]. The side effects of bisphosphonates are discussed in detail, separately. (See "Risks of bisphosphonate therapy in patients with osteoporosis".)

Other — Other causes of medication-induced esophagitis include potassium chloride, quinidine preparations, iron compounds, emepronium, alprenolol, and pinaverium [10].