What typically causes esophageal irritation, often referred to as "pill esophagitis"?

Pill esophagitis is primarily caused by certain medications that can irritate the esophagus. Antibiotics, particularly tetracyclines, are known for causing this condition when the pills do not dissolve properly and the medication remains in contact with the esophageal lining for an extended period. This constant exposure can lead to inflammation and irritation, which manifests as symptoms like pain or difficulty swallowing.

Other options like high-acid foods, excessive drinking, and prolonged fasting do not typically cause "pill esophagitis" in the same way. While high-acid foods and excessive drinking can irritate the esophagus, they do not relate specifically to the irritation caused by intact medications sitting in the esophagus. Prolonged fasting, while it may have other effects, does not cause localized irritation in the same manner as direct contact with irritating substances like antibiotics. Thus, the link between tetracyclines and esophageal irritation is a key aspect of understanding pill esophagitis.