Unexpected caustic esophageal injury associated with the use of a bowel preparation agent

Bowel preparation is crucial for maintaining the quality of colonoscopic findings. Many bowel preparation agents are available that have a few adverse effects. However, inappropriate use of bowel preparation agents may cause severe complications that need immediate management. Sodium picosulfate with magnesium citrate (SPMC) is a widely used colon-cleansing agent. We present a case wherein inappropriate use of SPMC manifested as extensive esophageal ulceration. The patient did not comply with the drug instructions. Progressive chest tightness and epigastric pain developed after he took the drug. Upper endoscopy revealed caustic esophageal injury of the middle-to-distal esophagus. The patient was treated with a proton-pump inhibitor and sucralfate. There was no chronic complication during the 3-month follow-up period. The patient education regarding the correct use of SPMC should be prioritized by the clinician.