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Figure 4.7 Plasma concentrations of 400 mg acetaminophen in patients with delayed oesophageal transit (O) and normal transit (l)23

Endoscopy demonstrates a redness and friability of the mucosa, an erosion about the size of a coin, or a deep ulcer29. Occasionally particles of drug may be seen to be adhered to the mucosa. The majority of lesions are located at the level of the aortic arch or slightly above it (Figure 4.8). Less commonly lesions can be seen higher in the oesophagus, particularly in bedridden patients. Lesions have also bee reported in the lower third of the oesophagus, just above the gastro-oesophageal junction. In severe cases, stricture may result. Most patients are apparently healthy people who are suddenly hit by symptoms of oesophageal injury. Men and women alike are affected and patients between 9 and 98 years of age have been reported in the literature. A single dosage form can cause problems, particularly if the patient takes the tablets/capsules immediately before retiring to bed and without water. The patient wakes up a few hours later, or in the morning with severe retrosternal pain which is not relieved by drinking or eating. The patient avoids swallowing as it is painful. If medical attention is sought, a doctor will rule out heart disease and prescribe an analgesic or antacid. The pain can persist for days and will only resolve when the patients alters his method of taking medication.

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