Abstract
The objective of the present study was to assess esophageal motor function in 21 children (7.5 +/- 2.9 years) with caustic strictures. Esophageal manometry was performed using a water-infusion system interfaced with a polygraph and displayed on a computer screen. The data were compared with those obtained from 9 healthy children. Radionuclide transit was determined by studying deglutition of a single bolus of 99mTc pertechnetate in 10 ml of water. Non-peristaltic low-amplitude and long-duration waves were the most common findings detected in patients with strictures longer than 20% of esophageal length (N = 11). Compared with the control group, these patients presented lower mean amplitude and longer mean duration of waves (24.4 +/- 11.2 vs 97.9 +/- 23.7 mmHg, P < 0.05, and 6.7 +/- 2.4 vs 1.6 +/- 0.1 s, P < 0.05, respectively). Six patients presented low-amplitude waves just below the constricted site. Ten children presented delayed esophageal transit. There was an association between dysphagia and abnormalities on manometry (P = 0.02) and between symptoms and scintigraphy data (P = 0.01). Dysphagia in caustic strictures is due to esophageal motility abnormalities, which are closely related to the scarred segment.
Highlights
Infants and young children often accidentally ingest caustic agents
We report here the results of esophageal motility studies carried out on children with esophageal strictures caused by severe caustic accidents
There was no association between severity of acute esophageal injury and late dysphagia (P = 0.51, two tailed Fisher’s exact test)
Summary
Infants and young children often accidentally ingest caustic agents. Most accidents occur because children have access to strong household cleaners that were stored inappropriately in food and drink containers. Latin American children are more vulnerable because caustics are commercially available and there is no legislation requiring the manufacture of less concentrated products. A recent survey has reported up to 100 accidents per year at a single Health Unit in Montevideo, Uruguay, with most accidents involving children who had ingested sodium hydroxide or lye solutions [1]. Ingested liquid alkaline agents cause injuries to the entire esophagus, destroying even the full thickness of the organ wall [2]. A few months after the accident, different degrees of esophageal damage may be identified in 22 to 58% of affected children [3]. A deep circumferential burn involving muscles heals by fibrosis, causing a stricture that will
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