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Authors' reply to comment on “The usefulness of non-contrast abdominal computed tomography for detection of residual drugs in the stomach of patients with acute drug overdose”

or quantitative testing. Another issue with this work involves understanding the study hypothesis. Based on the authors’ conclusions, it seems that the authors’ primary objective was using CT scans as a noninvasive tool to locate pill fragments. However, if the objective was to determine if the drugs are present in the stomach at various times post ingestion, then we believe that question has already been answered. Direct endoscopic visualization of the stomach contents of overdose patients demonstrated that most patients presenting 2–4 hours post ingestion still had significant amounts of solid pills and partially dissolved material seen [3]. Using radiodensity to identify potential pill fragments is additionally problematic. Furthermore, autopsy studies show that patients can have pill fragments present at the time of death many hours post ingestion of drugs known to decrease bowel motility [4]. These studies demonstrate that pill fragments can be present at various times post ingestion. Clinical history, physical examination and a knowledge of the characteristics of the individual drugs involved play a large role in determining a treatment approach. Finally, in theory, we believe that visualization of pill fragments in the stomach on a CT scan could make a compelling argument for gastric lavage if the pills were known to be high-risk drugs for which there is no effective antidote. However, because of the high false-negative rate, management of a serious overdose should not be based on CT findings alone.