PATHOGENESIS — The mechanism of injury is believed to be due to prolonged contact of the caustic contents of the medication with the esophageal mucosa. Esophageal retention — Some degree of esophageal retention of pills or capsules occurs in normal individuals. However, the following situations enhance pill retention, thereby increasing the likelihood of esophageal injury: Both lack of an adequate liquid bolus and a long period in the recumbent position are believed to play a major role in pill retention. Ingestion of a pill immediately prior to sleep favors prolonged retention since salivation and swallowing frequency are markedly reduced during sleep.
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