Drug-induced corrosive injury of the oesophagus

Five patients are described who had retrosternal pains following the consumption of CetiprinR tablets. The pains increased so markedly within a few days that, initially, solid foods and, subsequently liquid foods also were impossible to swallow. Typically the history was of the comsumption of a tablet in the evening or night without fluids and the pains lasted 2--3 weeks. A marked corrosive injury of the middle third of the oesophagus was shown at oesophagoscopy in each case, but the mucosa of the lower one-third of the oseophagus was normal. Gastro-oesophageal reflux was not demonstrated radiologically in any of the patients. None of the patients developed a stricture of the oesophagus. The most likely alternative in the differential diagnosis was a foreign body. Oesophagoscopy should be performed on any patient in whom such pains persist for more than 4--5 days, even if the X-rays are normal. The physician should advise his patients to take tablets or capsules with fluids. This is especially important if the drug is taken in the evening or at night. CetiprinR tablets should be taken in the evening while the patient is still upright, and should be taken with fluids. If a corrosive injury does develop, we suggest that treatment should be with cortisone and with agents which protect the oesophageal mucous membranes.