A report on two patients with severe reflux oesophagitis caused by Emepromium Bromide (‘CETIRPIN’) prescribed for the treatment of urinary symptoms.

Emepronium Bromide is a quaternary ammonium anticholinergic drug, which blocks the peripheral cholinergic nerves and ganglionic transmission. In man it increase bladder capacity, delays the first desire to void and decreases voiding pressure.

In the last eighteen months two patients have been referred with severe pain on swallowing. The pain was localized behind the sternum and reached down to the epigastrium. On both occasions the symptoms came on rapidly a few days after the treatment was begun. Both patients were on a standard dose of 200 mgs. three times daily. The first patient had had some minor reflux with her last pregnancy thirteen years previously, but otherwise no symptoms suggestive of reflux. The second patient had never has any symptoms suggestive of oesophageal reflux. In both patients a major feature was the severity of their pain.

Abstract A CASE is presented in which a post-cricoid web was shown arising posteriorly instead of in the almost invariable anterior situation. The patient was not anaemic and some brief comments are made on the inconstant relationship between anaemia and the presence of a web.

Kelly (1919) related dysphagia to anaemia and described how ‘the gullet seemed closed by a web passing backwards from the cricoid’. Subsequent authors emphasize this and Waldenstrom and Kjellberg (1939) state that radiologically and at oesophagosopy there is ‘a thin semilunar membrane on the anterior wall stretching towards the lateral walls of the gullet’ Shamma'a and Benedict (1958) and Seaman (1967) state that webs arise anteriorly but may be circumferential.

This report presents a patient with longstanding dysphagia and anaemia in whom a posterior pharyngeal web was shown.