Endoscopic Characterization of Caustic Ingestion in Zambia

Abstract

Purpose: Ingestion of caustic agents can cause severe upper gastrointestinal damage. Data from developing nations is deficient due to under-reporting and lack of or late presentation to healthcare providers. AIM: To describe endoscopic findings of caustic ingestion. Methods: We conducted a retrospective cohort study, at University Teaching Hospital (UTH), a tertiary medical center in Lusaka, Zambia. We reviewed endoscopy records from January 1999 to May 2010 and searched for any mention of caustic ingestion. Parameters examined included age at presentation, gender, nature of the caustic substance ingested (acid or alkali), accidental or intentional and anatomical distribution of injury in the gastrointestinal tract. Results: We identified 43 cases of caustic ingestion. The mean age was 24 years, ± 8.7, and predominantly male 39/43 (90%). The most common caustic agent ingested was acid (53%) followed by alkali (47%). Endoscopic findings included gastric outlet obstruction (55%), esophageal stricture (30%), gastric ulcer (21%), pyloric ulceration (16%), gastritis (14%), esophageal ulceration (9%) and duodenal ulceration (2%). There was no difference in the endoscopic findings between men and women. The type of injury sustained was also not related to the type of substance ingested (acid or alkali). Data regarding situation of ingestion (accidental or intentional) was not available on endoscopy reports. Conclusion: The most common endoscopic outcomes were gastric outlet obstruction and esophageal stricture. Early diagnosis of caustic ingestion is important to guide treatment and prevent complications. Funding should be allocated towards raising public awareness.