Risk Factors Affect Outcome of Esophageal Injuries Caused by Caustic Ingestion in Children

Abstract

Purpose: Ingestion of caustic materials is a worldwide challenge. The study aim was to identify the factors that influence the outcome and prognosis of esophageal injuries after caustic ingestion in children. Methods: We retrospectively reviewed all files of patients with history of caustic ingestion, their endoscopy results and follow up, who were admitted at Pediatrics Gastroenterology ward of Aboozar Children's Hospital, Ahwaz, South -Western of Iran. Results: During 10 years (October 1998- 2008) a total of 81 children (mean 2.7, range 1-5 y), 46 male, with history of caustic ingestion were enrolled in our study. Ingestable alkaline were drain, pipe, oven, grill and barbecue cleaners, dish washer detergent and bleaches (Totally 61%) and acidic materials as drain openers, toilet cleaners and battery liquid (Totally 39%). The grade(G) of esophageal injury with regard of the ingested caustic materials was: GO (history of ingestion, no injury, 18.5% in bleaches ingestion), G1 (edema and erythema, no transmucosal injury, 11% in very small amount acid and dish washer ingestion), G2 a/b (transmural injury, hemorrhage, circumferential ulceration, 64% in large amount of acid ingestion and vomiting, alkaline ingestion and delay in hospital admission), G3 a/ b (scattered deep ulceration and necrotic tissue 6.5% in large amount of alkaline ingestion and vomiting and/ or delay in hospital admission). Our follow up study showed that 11 (13.5%) cases developed esophageal stricture about 3 weeks after caustic ingestion despite proper treatment including dexametasone and antibiotic (Picture). The stricture confirmed by a second endoscopy and contrast media study. All these 11 patients had grade 2+ esophageal injury. Dilatation by boogies or balloon was done for these cases and 2 of them needed further surgery treatment which 1 of them died.FigureConclusion: Caustic ingestion by children is a worldwide preventable medical problem. In this study, we found that the alkali, large amount of ingested caustic agent, delayed referral to hospital and treatment including vomiting after ingestion worsen the outcome and prognosis. Prevention is paramount.