The ingestion of strong acids and alkalis continues to be a significant problem in many parts of the world, particularly in developing countries. In children, ingestion is usually accidental while in adults, ingestion may be used to attempt suicide. It is difficult to ingest significant volumes of hydrochloric acid or sulphuric acid because of bitter smells and tastes. However, alkaline solutions have a milder taste and, because of this, are likely to be swallowed in larger amounts. Interestingly, approximately 50% of patients who claim caustic ingestion have no significant injury. An important feature of caustic ingestion is the presence of laryngeal and pharyngeal injury. Almost all patients with significant caustic ingestion have pharyngeal pain, excessive salivation, nausea and difficulty with swallowing. Most of these symptoms appear to resolve spontaneously as there are few reports of longer-term pharyngeal symptoms. However, inflammation with both acids and alkalis can result in strictures in the esophagus, stomach and duodenum. These strictures can be difficult to dilate and, in the esophagus, are associated with an increase in risk for carcinoma. In the patient illustrated below, caustic ingestion appeared to be responsible for deformity of the tongue as well as the late development of an esophageal stricture. A 37-year-old woman was investigated because of a 4 month history of progressive dysphagia. She did not describe esophageal reflux or heartburn and, despite difficulty with swallowing, her weight had remained stable. The only abnormality on examination was an unusual tongue with a ‘rolled-up’ tip (Fig. 1). A barium swallow examination showed a stricture at the junction of the mid and upper esophagus with mild proximal dilatation (Fig. 2). Upper gastrointestinal endoscopy confirmed the presence of a stricture that was dilated to 15 mm using Savary-Gillard dilators. She remains asymptomatic after follow-up for 3 months. Caustic ingestion was considered a possible cause of the esophageal stricture because of the presence of a deformed tongue. On further questioning, she mentioned that she had been told by her parents that she had accidentally ingested a caustic solution at the age of 2 years. This was followed by ulceration of the tongue that healed over a period of 1 month. During that time, she was fed on sips of fluid. In a minority of cases, the interval between caustic ingestion and the development of esophageal strictures can be quite long. In the above case, this appeared to be 35 years.