P1037 LARGE DOSES OF STEROIDS IN SEVERE CAUSTIC ESOPHAGITIS IN CHILDREN. A TUNISIAN MULTICENTRIC STUDY

Abstract

Introduction: Prevention of caustic secondary strictures with steroids is controversed (1). Promising results have been reported with intravenous shots of high doses of methylprednisolone in a small series of children (2).The aim of this multicentric study is to assess the influence of early management of severe esophageal burns with large doses of steroids in the occurrence of esophageal stricture. Methods: 106 children (66 males and 40 females) with a mean age of 3 years and nine months (range: 14 months and 11 years) with a second b- (n=43) or third-degree (n=63) esophageal burns due to accidental ingestion of caustic substance were included in a study between 1993 and 2002. Corrosive substances ingested were sodium hydroxide (n=65), KOH (n=13), bleach (n=13), sodium hydroxide plus bleach (n=2), alkali (n=9), acid (n=3), others (n=1). Upper GI endoscopy was performed in all the children within 24 hours of caustic ingestion. All patients received daily IV shots of methylprednisolone (1g/1.73 m2/day during 6 to 15 days depending on the results of the endoscopic follow-up after one week) plus anti-secetory drugs (anti-H2 or omeprazole) and ampicilin plus early oral feeding resumption (Protocol of the French Working Group of Pediatric Gastroenterology, Hepatology and Nutrition (2)). Results: On day 30 of the protocol, second b- degree esophagitis complicated with an esophageal stricture in 10 cases (23.2%). Nine of them underwent a median of 3.4 esophageal dilations (range: 2–10) and one had a surgical replacement of the esophagus with a segment of colon. After a median follow-up of 1.6 years, seven of them have a normal esophagus. Nineteen children (30%) with a third-degree esophagitis developed an esophageal stricture. Sixteen of them underwent a median of 2.7 esophageal dilations (range: 1–8) and 3 had a surgical replacement of the esophagus with a segment of colon. Steroids complications included: gastric (n=4) and esophageal (n=1) perforations, pulmonary (n=1) and nosocomial (n=1) infections, and transitory hypertension (n=2). Conclusion: Large dose of corticosteroids seem to improve severe caustic esophagitis prognosis and may prevent from esophageal stricture.