Caustic Injuries of the Esophagus

Abstract

Caustic ingestion continues to be a significant problem worldwide, especially in developing countries and particularly in the under 6 years age group. The presence or absence of symptoms or oral lesions does not reliably predict the existence or severity of esophageal lesions. Upper endoscopy remains the mainstay diagnostic modality for evaluation to define the extent and severity of the injury. The best predictor of morbidity and mortality is the extent of injury as assessed during the initial evaluation. Early management strategies for caustic ingestion are well defined. Controversy still surrounds the use of steroids, antibiotics, antacid therapy in the acute phase, and the use of esophageal stents and the frequency, timing, and method of dilatation in the prevention and management of esophageal strictures. There is a pressing need for noninvasive diagnostic modalities and effective therapeutic options to evaluate and treat the complications associated with caustic ingestion. Indications for definitive surgery or bypass and the type of procedure to use are also subject to ongoing debate. Novel therapies, including tissue engineering, are still in the animal study phase and may not be clinically applicable for years to come.