Acute severe intravascular haemolysis: an unrecognised cause of pancreatitis.

study showed a significant reduction in lower oesophageal sphincter pressure after intramuscular administration of emepronium bromide. In the nine patients who completed the study no significant change in sphincter pressure was found after four weeks' treatment with a standard oral dose of emepronium bromide. This may have been due to the much lower serum concentrations seen after oral medication than after intramuscular injection, confirming the findings of Ritch et al.5 A local irritative effect of the tablets is probably the most common cause of oesophageal injury after oral medication, as no decrease in sphincter pressure was shown during oral treatment with emepronium bromide. Since, however, higher plasma concentrations ofemepronium bromide decrease the sphincter pressure and the absorption of the drug from the gastrointestinal tract varies considerably, occasional high serum concentrations may be seen. This, combined with an individual variability in parasympathetic receptor sensitivity, might cause the lower oesophageal sphincter to relax, causing more severe cases of reflux oesophagitis in the lower oesophagus.