Accidental Caustic Exposure from Ingestion of Contaminated Beer: A Case Series.

Introduction: This report presents three cases of unintentional ingestion of beer line cleaner (BLC), a strongly caustic alkaline solution (pH 13-14). In each incident, unflushed BLC entered the draft system and was served as drinkable beer (pH 4.0-4.5) in different taverns due to deficiencies in regulatory oversight and enforcement. Case Presentations: A 37-year-old female, a 37-year-old male, and a 40-year-old male presented with esophageal injuries after consuming contaminated beer in unrelated events. Endoscopy revealed findings ranging from erythema and esophageal nodules to benign strictures and very severe Grade D esophagitis. Patients required extended proton pump inhibitor therapy and dietary changes, and they experienced ongoing symptoms, including dysphagia, reflux, taste alterations, and weight loss. Conclusion: This case series highlights the serious and lasting consequences of BLC ingestion and underscores the need for standardized beer line flushing protocols, tracer dyes, and point-of-use testing to prevent future exposures in commercial establishments where uniform regulations are insufficient. It also demonstrates the underreported health risks associated with accidental BLC ingestion. Greater physician awareness can facilitate earlier diagnosis and treatment and improve outcomes. Enhanced reporting of BLC ingestion can increase identification of caustic hazards and strengthen public health awareness of this largely unrecognized risk.