Drug-induced corrosive injury of the oesophagus

Abstract

Five patients are described who had retrosternal pains following the consumption of Cetiprin [used in the treatment of nocturia and urinary incontinence] tablets. The pains increased so markedly within a few days that initially solid foods and subsequently liquid foods were also impossible to swallow. Typically the history was of the consumption of a tablet in the evening or night without fluids and the pains lasted for 2-3 wk. A marked corrosive injury of the middle third of the esophagus was shown at esophagoscopy in each case, but the mucosa of the lower 1/3 of the esophagus was normal. Gastro-esophageal reflux was not demonstrated radiologically in any of the patients. None of the patients developed a stricture of the esophagus. The most likely alternative in the differential diagnosis was a foreign body. Esophagoscopy 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. Cetiprin 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, treatment should be with cortisone and with agents which protect the esophageal mucous membranes.