Caustic ingestion in Tunisian children: Endoscopic findings, complications and predictors of severe injuries in a cohort of 1059 patients

Abstract

Background and aimsThe ingestion of caustic substances remains a serious medical problem in Tunisian children. This study was conducted to describe the epidemiological, clinical, and endoscopic findings of caustic ingestion in Tunisian children, and to indentify predictive factors of severe esophageal and gastric injuries. Patients and methodsA retrospective review of all children referred to a tertiary pediatric center for caustic ingestion who underwent esophago-gastro-duodenoscopy was conducted. Severe esophageal and gastric injuries were defined as Grade 2b, 3a, 3b, and 4 using the Zargar classification. We conducted multivariate logistic regression analysis to identify predictive factors for severe esophageal and gastric caustic injuries. ResultsWe analyzed 1059 diagnostic procedures performed for caustic ingestion. The mean age was 41.4± 31.9 months. The most frequently ingested caustic substance was household bleach followed by caustic soda granules. Endoscopy showed severe esophageal and gastric lesions, respectively, in 122 (11.5%) and 56 (5.3%) cases. Predictive factors of severe esophageal injuries were: alkaline ingestion (p<0.001; OR: 17.9; 95% CI: 8.4–38.1) and the presence of symptoms after caustic ingestion (p=0.02; OR: 2.4; 95% CI: 1.1–5.4). The occurrence of complications was significantly associated with the presence of severe gastric lesions at the initial procedure (p=0.046; OR: 2.3;95% CI: 0.9– .3). ConclusionEsophago-gastro-duodenoscopy should always be performed for symptomatic children, asymptomatic children who have ingested an alkaline product, and asymptomatic children under the age of 6 years.