Theophylline Oesophageal ulceration with slow release preparation

A burning pain behind the sternum, in the right breast, and in the right side of the back developed in a 31 -year-old woman several hours after she swallowed, without liquid , a slow release theophylline tablet (,Phyllocontin 350') while l ying down. For 9 days the woman was unable to swallow without experiencing pain and sometimes also vomiting.

An upper gastrointestinal endoscopy showed an oesophageal ulcer 2cm long which covered all but the right lateral side of the oesophagus. In appearance, 'the ulcer was deep, nodular at the edges, and had some shaggy areas in its base' . Histology was unable to identify the cause of ulceration, A second endoscopy, 20 days later, showed normal oesophageal mucosa.

In conclusion , the ' . . . oesophageal ulcer was presumed to be due to theophylline since there is no evidence of any other cause ' . Thus, 'patients should be advised to take all oral medication while erect or sitting up and with enough fluid (about 200ml), . StOller. J.L Lancet 2: 328·329 (10 Aug 1985)