Abstract
INTRODUCTION: Patients with caustic ingestion present with a range of gastrointestinal (GI) manifestations. The severity of injury depends on the type of substance ingested, its concentration, and duration of contact with the GI mucosa. Apart from usual supportive care, esophagogastroduodenoscopy (EGD) performed within 24 hours of ingestion is generally recommended. This study reports clinical, endoscopic features and hospital outcomes in patients presenting following ingestion of a caustic agent at a single large academic center. METHODS: A retrospective chart review was performed at two academic hospitals between January 2000 and October 2018 in adult patients presenting with caustic ingestion. Demographic data, type of ingestion, endoscopy and computed tomography (CT) findings, in-hospital mortality and length of stay (LOS) was collected. (Table 1). RESULTS: A total of 89 patients were included in the study. Suicidal ingestion occurred in 49.4% cases compared to accidental. The mean age was 43 ± 20 years with 50.6% males. Ingestion of alkalis (81.0%) was higher than acids (15.7%). The most common presenting symptom was vomiting (31.5%). Endoscopy was performed in 54 patients (60.7%) with 45 (83.3%) performed within 24 hours. Endoscopic findings are summarized in Table 2. Patients undergoing endoscopy had a longer duration of hospitalization (5.58 vs 1.67 days, P < 0.001). Patients with Zargar grade 0 had shorter hospitalization compared to those with grade IIA-IIB esophagitis (2.87 vs. 7.53 days, P < 0.001). However, there was no difference in LOS when comparing grade II to III esophagitis (8.4 vs. 11.2 days, P = 0.238). All patients with grade IIA-IIIB were started on a PPI during hospitalization. Only 19.1% of patients had a CT with the majority (70.6%) being normal. Death occurred in 3 patients. CONCLUSION: In this single center cohort, patients mainly presented with alkali ingestion with varying symptoms. An endoscopy was performed in about 60% patients, most within 24 hours and the majority of patients demonstrated Zagar scores of 0 or 1. Despite recent data suggesting cross-sectional imaging as a triage tool, its utilization in this academic center was limited. Implementing a CT-first strategy prospectively may provide additional data and may minimize the utilization of inpatients endoscopy. To our knowledge, this is one of the largest samples to date on caustic ingestion in the United States.
Published Version
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