How a pill without water can burn a hole in your throat: One doctor learns the hard way never to gulp down tablets

Painful: Dr Max Pemberton found out the hard way how damaging it can be to take a tablet without water (picture posed by model)

A spoonful of sugar makes the medicine go down, as Mary Poppins once sang. But it would have been even more pertinent to advise always taking said medication with a large glass of water.

As a doctor, I'm used to rattling off words to this effect (the water bit, not sugar) as I hand over a prescription. But if, like me, you find it quite easy to just swallow a pill ‘dry’, you probably will. Sometimes, a glass of water means getting up from your desk.

And if they say ‘take with food’ but you forget at meal time, there’s no real harm in breaking the rule once, is there? Wrong.

I discovered the hard way just how dangerous what we medics call poor pill-taking habits can be. I am a perfectly fit, healthy 30-year-old. But because of just one antibiotic tablet, taken wrongly, I ended up in hospital for a week, and off work for a further six.

It started when I woke up one morning and went to get a glass of water. Still half asleep, I stood in the kitchen and took a gulp.



As I swallowed there was a sharp, excruciating pain across my chest and the water shot back out of my mouth.

The pain was so severe, I actually looked down to see if something had stabbed me.



Nothing. I tried again and the same thing happened, only this time the pain was so much it bent me double and brought tears to my eyes. By the end of the day, I still hadn’t been able to swallow anything, even saliva.

I went to bed that evening, thirsty and hungry but concluding that whatever it was would go by the morning. It didn’t. By the next evening, a friend who works in A&E came round to visit and was horrified.



Still unable to drink, I was badly dehydrated and my tongue had started to swell. She concluded that I was going into acute renal failure – whereby the kidneys stop working properly because of dehydration – and I was rushed into hospital.



Bitter: Dr Max Pemberton suffered excruciating pains across his chest after taking a tablet without much water

Rather embarrassingly, it was the hospital I work in. My colleagues fussed around me, desperately worried. I was given a drip to rehydrate me, while they scanned my heart and did X-rays of my chest.



The pain came on only when I tried to swallow – an excruciating stabbing sensation that took my breath away.

After each attack, I was left shaking and sweaty due to the pain. They were at a loss to find what was wrong. They offered painkillers, but I was unable to swallow them.



I saw five separate consultants, all of whom scratched their heads. Eventually they took me to theatre to look down into my oesophagus under general anaesthetic.

'One of the tablets I had taken had got stuck in my throat. There were no pain nerves in that part of the oesophagus, so I hadn’t noticed as, over several weeks, it slowly broke down and eroded through the delicate tissue, burning a hole through to the muscle underneath. '

There, they found scar tissue and an obstruction. What could have caused so much damage, they asked? I shrugged my shoulders. By chance, a junior doctors asked if I’d taken any tablets recently.



About two weeks before I’d been on a short course of the antibiotic doxycycline for a chest infection.



It transpired that one of the tablets I had taken had got stuck in my throat. There were no pain nerves in that part of the oesophagus, so I hadn’t noticed as, over several weeks, it slowly broke down and eroded through the delicate tissue, burning a hole through to the muscle underneath.

This had been my fault – the tablet had got stuck because I’d swallowed it in a hurry without water, as I often did. I was astounded. And although what happened to me is apparently not uncommon, it is not something patients are routinely warned about.

Some medications are highly corrosive – either very acidic or very alkaline. The stomach cells are protected by mucus. But trapped in the oesophagus, the contents of the tablet burn, causing ulcers and scarring.

They can even burn right through, with fatal consequences. Sarah McMahon, who works in the A&E department of an East London teaching hospital, has come across several patients in the past year with this complaint. ‘People just don’t realise that when it says they must take these tablets with water, it really is important,’ she told me.

To date, more than 100 medications have been found to cause pillinduced oesophagitis – including Vitamin C, iron supplements, aspirin and other non-steroidal anti-inflammatory drugs such as ibuprofen, as well as numerous antibiotics.

Thankfully, once halted the problem usually resolves on its own, although it can take several months to fully heal. It took two weeks before I could swallow solid food and I lost a stone in weight as a result. So, take tablets one at a time with a full glass of water.

Drink further glasses of water if you feel the tablet hasn’t gone down. Wait 15 minutes before going to bed or lying down after taking tablets. Hopefully, you’ll learn from my mistake.