Ingestion Of Caustic Substances Research Articles

A simple machine learning approach for preoperative diagnosis of esophageal burns after caustic substance ingestion in children

A simple machine learning approach for preoperative diagnosis of esophageal burns after caustic substance ingestion in children

Neutrophil to Lymphocyte Ratio As A Predictor of Endoscopic Damage in Caustic Injuries

Objective: To assess the ingestion of caustic substances is a medical emergency and esophagogastroduodenoscopy (EGD) is helpful in diagnosis, prognostication and management. Here, we investigated the NLR of patients, to assess the correlation of neutrophil lymphocyte ratio (NLR) with degree of caustic injury and to evaluate whether NLR can predict the degree of caustic endoscopic injury. Method: This cross sectional study was carried out on 180 patients in gastroenterology department of DHQ teaching hospital, Gujranwala from 1st Jan 2021 to 31 Dec 2021. The endoscopy was performed and CBC was sent for analysis of NLR. The esophageal and stomach mucosal injury was graded by Zargar's classification and divided into low grade and high grade. Independent sample t test was used for comparison between mean NLR versus low and high grade injury. Results: Patients with high grade damage has remarkably higher values of NLR as compared to low grade. For prediction of grade of damage, ROC analysis was used and AUC (area under curve) value was 0.838 (95% CI (0.783-0.894, p<0.001) and if we take NLR cut-off value as 3.5, the sensitivity will be 96.0% and specificity 63.3%, if we take cut-off value as 4.5, the sensitivity will be 93.1% and specificity 48.1% and if we take cut-off value as 5.5, the sensitivity will be 75.2% and specificity 35.4%. Conclusion: Neutrophil to lymphocyte ratio can predict degree of gastroesophageal injury in patients with caustic ingestion.

The Dire yet Regrettable Cause of Upper Gastrointestinal Bleeding: Caustic Substance Ingestion

The Dire yet Regrettable Cause of Upper Gastrointestinal Bleeding: Caustic Substance Ingestion

Examination of Clinical, Endoscopy and One-Year Follow-Up Findings of Children with Accidental Ingestion of Caustic Substances Admitted to Shahid Sadoughi Hospital (2016-2019)

Introduction: Accidental ingestion of caustic substances can cause serious damage to the digestive system. This study was conducted with the aim of investigating the incidence of esophageal stricture within one year after accidental ingestion of caustic substances and its relationship with the first endoscopic findings in children.
 Methods: The present study was a retrospective and cross-sectional study that has been conducted for 3 years on children with accidental ingestion of caustic substances referred to Shahid Sadoughi Hospital in Yazd City (August 2015-2015). Demographic information, type and amount of ingested material, initial symptoms, initial endoscopic findings and degree of esophageal tissue burn were recorded and the patients were followed up for one year. Finally, the data were analyzed by SPSS version 22 software.
 Results: In this study, 55 children were evaluated, their average age was 3.19 years. Participants consisted of 23 (41.8%) girls and 32 (58.2%) boys. Children had ingested pipe openers chemicals (30.9%), bleach liquid (29.1%) and hydrochloric acid (12.7%), respectively. Initial endoscopic findings were normal in 45.5% of children, and the most damage was grade IIb and IIa. The incidence rate of esophageal stricture in month later was 47.3%, and in the year later, the total incidence of stricture and GOO was 27.3% (16.4% of esophageal stricture and 7.3% of stricture and GOO).
 Conclusion: The present study showed that esophageal injury following the accidental ingestion of caustic substances is common in children, and the presence of symptoms in the patients at the beginning of the visit can be associated with higher grade injuries, and the occurrence of stricture is more common after severe injuries.

Ingestion of corrosive substances and the endoscopic role in assessing the severity of caustic injury.

The ingestion of caustic substances into the upper gastrointestinal tract is an unusual but potentially life-threatening problem. To evaluate the most commonly ingested corrosive substances, and the endoscopic findings, complications, and final outcomes of caustic intake. This cross-sectional study included 220 inpatient participants with corrosive poisonings during a 3-year period (2017-2019). Data from the national patient electronic system "My term" and from the "Poisoning information centre" at the University Clinic for Toxicology, Skopje were used. Demographic characteristics, type of corrosive substance, endoscopic findings by Kikendall classification, emerging complications, fatal outcome, and hospitalization were analysed. Data obtained were analysed with the SPSS software package, version 22.0 for Windows. During the period 2017-2019, out of 220 hospitalized cases with corrosive substance intake, 132 (60%) were with ingestion of acids, 19 (8.6%) with bases, 32 (14.6%) with bleaches, and 37 (16.8%) with other household products (p = 0.3469). The mean age of patients was 49.89 ±19.86 years. The most severe endoscopy findings (high-grade injury) were significantly more often associated with acid and base ingestion (p = 0.00001). Out of all strictures, 25 (64.1%) were on one location (either oesophagus or stomach), and 12 (30.8%) were on 2 locations. Upper gastrointestinal endoscopy is very important procedure for rapid assessment of severity of caustic injury, early appropriate therapy, as well as the potential development of strictures. The obtained data are very important for the development of a national program for the prevention of corrosive poisoning in our country.

Catastrophic Upper Gastrointestinal Tract Complications Following Corrosive Ingestion

Ingestion of caustic substances, either acidic or alkali, is a well-known cause of significant mortality and morbidity in the pediatric and adult populations. According to the pH, physical form, amount, and rate of ingestion of these substances, a wide range of immediate as well as possible subsequent chronic complications can result. Some patients may have minimal to mild symptoms. However, others can present with moderate or even serious symptoms, in the form of dysphagia, odynophagia, hoarseness, and epigastric pain. Herein we present a case of a 26-year-old male patient with a history of Nitric acid ingestion. He initially complained of severe chest and abdominal pain, associated with hematemesis, dysphagia, odynophagia, hypersalivation, and inability to tolerate oral intake. Initial Esophagogastroduodenoscopy (EGD) showed diffuse mucosal ulceration reaching the second part of the duodenum. Multiple subsequent EGDs revealed more extensive damage and subsequent esophageal stricture and pyloric stenosis for which multiple dilatation attempts were done. The patient received extensive supportive management during his hospitalization course, but the damage was severe enough that he was referred for surgical management. Such catastrophic sequels of caustic ingestion are still encountered, especially in developing countries. We present this case looking forward to raising awareness about this dangerous phenomenon and highlighting the significance of immediate identification and grading of the injury.

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

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.

The Impact of COVID-19 Pandemic on Caustic Ingestion at a Tertiary Care Center in South India

Background: The COVID-19 pandemic has had a significant impact on the mental health of individuals which has sometimes led to attempts at deliberate self-harm including the ingestion of caustic substances. This study was aimed to compare the rates of caustic substance ingestion during the pandemic to a similar period in the preceding year at our center. Methodology: We carried out a retrospective analysis, in which patients' details (demographic, clinical, endoscopic, and outcomes) were collected and compared between April 2019 and December 2019 (pre-COVID-19 pandemic) and from April 2020 to December 2020 (during the COVID-19 pandemic). Results: A total of 41 patients were included in this study, 26 (63.4%) in the pandemic period and 15 (36.5%) in the prepandemic period. The majority were female in both the prepandemic (60%) and pandemic periods (53.9%). More adolescents (&lt;18 years of age) were seen in the pandemic period (15.3%) than in the prepandemic period (6.7%). The proportion of patients admitted with caustic substance ingestion in the pandemic period (3.53%) was significantly higher than in the prepandemic period (1.57%) (P = 0.0094). Conclusion: Caustic substance ingestion almost doubled in our center during the COVID-19 pandemic highlighting the burden of mental health issues during a pandemic.

Tracheoesophageal Fistula with Secondary Mediastinitis due to Infants Ingesting Caustic Substance: A Case Report and Literature Review

The ingestion of caustic substances is an important cause of emergency care, with children under 5 years of age being the highest risk age group. Tracheoesophageal fistula is an uncommon complication, but with high severity, being associated with mortality of up to 40% when combined with mediastinitis. The objective of this report is to present the case of ingestion of a caustic substance by a 9-month-old infant, describing the clinical and operative management, as well as a brief literature review.

Profiling of inflammatory cytokines in patients with caustic gastrointestinal tract injury.

Study of inflammatory cytokines in patients with caustic gastrointestinal tract injury is sketchy. This study investigated the cytokine profiling of patients with caustic substance ingestion, and analyzed the differences between patients with severe and mild injury. This prospective, cross-sectional study enrolled 22 patients admitted to Chang Gung Memorial Hospital between March and October 2018. All patients underwent esophagogastroduodenoscopy in 24 hours. Patients were categorized into two subgroups, as mild (<2b, n = 11) or severe (≥2b, n = 11) group. The neutrophil count was higher in severe than mild group (P = 0.032). Patients in mild and severe groups exhibited significantly higher circulating inflammatory cytokines than healthy control, including interleukin (IL)-2, IL-5, IL-8, IL-9, IL-12, IL-13, interferon-gamma inducible protein-10, macrophage inflammatory protein-1 beta, regulated upon activation, normal T cell expressed and presumably secreted and tumor necrosis factor-alpha. Furthermore, the levels of IL-2 and tumor necrosis factor-alpha were significantly higher in patients with severe group than mild group. Although there was no difference in cumulative survival between both groups (P = 0.147), the severe group received more operations (P = 0.035) and suffered more gastrointestinal complications (P = 0.035) than mild group. Caustic substance ingestion produces mucosal damages and leads to excessive neutrophils and inflammatory cytokines in peripheral blood.

Management of Patient With Caustic Ingestion Injury: A Case Report

The ingestion of caustic substances, both accidental and voluntary, determines a complex syndrome,characterized by severe, often irreversible, visceral lesions, with still remarkable mortality in highlycompromised patients. Al36-year-old woman came to Emergency-Room with the chief complaints ofblackish vomiting about 4ltimes after drinking liquid to clean the bathroom floor. Patients with findings ofgrade 2B esophageal injury, pangastritis and gastric ulcer on endoscopy have high the risk of perforationand complications. Endoscopy done within 12lhours and no later than 24lhours following caustic ingestionto classify mucosal injury subsequent to caustic ingestion is useful to determine the severity of injury,particularly in suicidal cases, and thus helpful in predicting outcomes. Patient threat with rehydration withnormal saline, total parenteral nutrition, pump omeprazole, injection of methylprednisolone, antibiotic,and sucralfate. Consultation with the Psychiatry department has been conducted psychoeducation andpsychotherapy.

Caustic and Toxic Ingestions

Ingestion of caustic substances remains a potentially fatal public health concern with extensive morbidity and the possibility of long-term sequelae. The management strategies of these complex injuries continue to be extensively studied in the literature. Areas of interest include the most efficacious treatment of caustic esophageal stricture to preserve the native esophagus, use of steroids, and use of esophageal stents. Prevention of accidental ingestion through strategies to limit the availability of caustic substances is a key factor in reducing the incidence of injury, but there continues to be a high rate of accidental ingestion in developing countries with less rigorous manufacturing standards. Initial evaluation includes endoscopic evaluation of the esophagus and tracheobronchial tree. Optimal treatment strategies, including the use of proton pump inhibitors to reduce gastroesophageal reflux, steroid use to prevent stricture formation, and use of stents for management of strictures, continue to be debated. Initial surgical management includes esophagectomy for full-thickness injury with abdominal exploration. Multiple surgical options exist for both restoration of gastrointestinal continuity after esophagectomy and the management of strictures refractory to medical management, including reverse gastric tube, colonic interposition, and gastric advancement. Numerous small studies have evaluated the efficacy of these interventions, but there continues to be a need for larger prospective studies to develop a worldwide consensus opinion on best practices. We provide a review of the recent literature and practice recommendations for the management of injuries due to caustic ingestion. This review contains 7 figures, 10 tables, and 51 references. Key words: caustic ingestion, endoscopic management, stricture, surgical management

Caustic and Toxic Ingestions

Ingestion of caustic substances remains a potentially fatal public health concern with extensive morbidity and the possibility of long-term sequelae. The management strategies of these complex injuries continue to be extensively studied in the literature. Areas of interest include the most efficacious treatment of caustic esophageal stricture to preserve the native esophagus, use of steroids, and use of esophageal stents. Prevention of accidental ingestion through strategies to limit the availability of caustic substances is a key factor in reducing the incidence of injury, but there continues to be a high rate of accidental ingestion in developing countries with less rigorous manufacturing standards. Initial evaluation includes endoscopic evaluation of the esophagus and tracheobronchial tree. Optimal treatment strategies, including the use of proton pump inhibitors to reduce gastroesophageal reflux, steroid use to prevent stricture formation, and use of stents for management of strictures, continue to be debated. Initial surgical management includes esophagectomy for full-thickness injury with abdominal exploration. Multiple surgical options exist for both restoration of gastrointestinal continuity after esophagectomy and the management of strictures refractory to medical management, including reverse gastric tube, colonic interposition, and gastric advancement. Numerous small studies have evaluated the efficacy of these interventions, but there continues to be a need for larger prospective studies to develop a worldwide consensus opinion on best practices. We provide a review of the recent literature and practice recommendations for the management of injuries due to caustic ingestion. This review contains 7 figures, 10 tables, and 51 references. Key words: caustic ingestion, endoscopic management, stricture, surgical management

Management of Patient with Caustic Ingestion Injury: A Case Report

The ingestion of caustic substances, both accidental and voluntary, determines a complex syndrome, characterized by severe, often irreversible, visceral lesions, with still remarkable mortality in highly compromised patients. Al36-year-old woman came to Emergency-Room with the chief complaints of blackish vomiting about 4ltimes after drinking liquid to clean the bathroom floor. Patients with findings of grade 2B esophageal injury, pangastritis and gastric ulcer on endoscopy have high the risk of perforation and complications. Endoscopy done within 12lhours and no later than 24lhours following caustic ingestion to classify mucosal injury subsequent to caustic ingestion is useful to determine the severity of injury, particularly in suicidal cases, and thus helpful in predicting outcomes. Patient threat with rehydration with normal saline, total parenteral nutrition, pump omeprazole, injection of methylprednisolone, antibiotic, and sucralfate. Consultation with the Psychiatry department has been conducted psychoeducation and psychotherapy.

Caustic ingestion: CT findings of esophageal injuries and thoracic complications.

Ingestion of caustic substances, whether accidental or for the purpose of suicide, can cause severe lesions of the lips, oral cavity, pharynx, upper gastrointestinal system, and upper airways. In particular, caustic agents could be responsible for severe esophageal injuries resulting in short- and long-term complications. Because of these important clinical implications, timely diagnosis and appropriate management are crucial. In the evaluation of esophageal injuries, thoraco-abdominal computed tomography (CT) is preferable to endoscopy as it avoids the risk of esophageal perforation and allows the evaluation of esophageal injuries as well as of the surrounding tissue. In this review, we report CT findings of esophageal injuries and possible related thoracic complications caused by caustic ingestion.

Foreign Body and Caustic Substance Ingestion in Childhood.

Foreign body and caustic substance ingestion in childhood are common and require accurate and timely diagnosis to provide appropriate management consistent with the ingested substance/foreign body and clinical presentation as well as the associated risk status to prevent significant complications and morbidity. The aim of this paper was to present foreign body and caustic ingestion in childhood in terms of epidemiology, pathophysiology, diagnostic work-up and appropriate management and potential complications in accordance with clinical presentation and the type of ingested substance/foreign body.

A new perspective of the risk of caustic substance ingestion: the outcomes of 468 patients in one North Taiwan medical center within 20 years

Introduction Caustic substance ingestion is frequently life-threatening, and its pathological mechanisms of tissue damage are well documented. However, few studies have assessed the combined effects of pH and the ingested dose on patient outcomes. Additionally, the miscellaneous chemical properties are not immediately available for providing predictive insights to physicians. This study aimed to provide a new perspective of the risk assessment of caustic substance ingestion based on the pH and dose. Methods The retrospective study analyzed adults treated for caustic substance ingestion at Chang Gung Memorial Hospital between January 1999 and December 2018. Uniformly strict inclusion/exclusion criteria and a double-checked process during chart review were adopted. All patients underwent urgent esophagogastroduodenoscopy (EGD) within 24 h. Caustic mucosal damage was graded using Zargar’s modified endoscopic classification. The pH and ingested dose of caustic substances were clearly recorded. Statistical analyses were conducted using IBM SPSS, version 22. Results Based on the 468 enrolled cases, the pH and dose were valuable predictors of the extent of gastrointestinal tract injury, commonly encountered complications, and long-term overall survival outcomes. Risks of mortality and perforation were dose-dependent for acids and pH-dependent for alkalis. The severe EGD findings (grade ≥ 2b) in this study were pH-dependent for both substances and additionally dose-dependent for acids. Conclusion Combining pH and dose, we proposed a new perspective for the risk assessment of caustic substance ingestion. Such findings may provide predictive insights for resolving clinical uncertainty before the availability of examination results. “Large doses of acids” and “high pH of alkalis” deserve special attention. This new perspective with a retrospective nature requires further validation.

Assessing the Degree of Acute Esophageal Injury Secondary to Corrosive Intake: Insights From a Public Sector Hospitals of a Developing Country.

BackgroundCaustic ingestion continues to be a significant problem worldwide especially in developing countries and particularly in the age group of under six years. Ingestion of caustic substances is a medical emergency in both the adult and pediatric population and is associated with high morbidity and mortality. The ingestion of caustic substances induces an extensive spectrum of injuries to the aerodigestive tract, which includes extensive necrosis and perforation of the esophagus and stomach.ObjectivesThe main aims were to determine upper and lower esophageal injuries associated with corrosive intake and to compare esophageal injury with age and gender.RationaleOnce we’ll find the extent and severity of esophageal injury associated with corrosive intake within 24 hours, we’ll be able to manage the case timely and to limit further complications and disabilities.Materials and MethodsThis descriptive cross-sectional study was conducted on 150 patients who presented with corrosive ingestion and underwent urgent endoscopic evaluation. Data were collected using self-designed pro forma. Endoscopic findings were classified according to the Zargar classification. A descriptive analysis of study variables was performed using SPSS v.21.0 (IBM Corp., Armonk, NY, USA). The chi-square test was used, and a p-value of less than 0.05 was considered statistically significant.ResultsOut of 150 patients under study, 103 (68.7%) were females and 47 (31.3%) were males. The most prevalent age group presenting with corrosive intake was found to be between 21 and 34 years of age (43.3%) in both genders. The most common part of the esophagus prone to corrosive insult is the upper esophagus (99.3%), whereas, regarding severity, the lower esophagus has more severe injuries (predominant being stage 2B, i.e., 32%). There are no statistically significant differences in esophageal injuries in different age groups (upper esophageal injury: 0.319; lower esophageal injury: 0.696) and genders (upper esophageal injury: 0.769; lower esophageal injury: 0.752). ConclusionsMost of the patients under study belong to the female gender and teen and younger age group. The predominant upper esophageal injury as a result of corrosive intake is stage 0 injury, and the least common is found to be stage 1 injury. The predominant lower esophageal injury as a result of corrosive intake is stage 2B injury, whereas the least common is found to be stage 4 injury.

The Association Between Caustic Ingestion and Psychiatric Comorbidity Based on 396 Adults Within 20 Years.

PurposeHigh prevalence of psychiatric comorbidities (PCs) has been widely documented in caustic substance ingestion cases. However, their effect on the clinical features and prognostic outcomes remains unclear due to the paucity of discussion. We report on detailed clinical courses with long-term multifaceted outcomes and review the association between caustic ingestion and each specific PC.Patients and MethodsThe retrospective chart review included 396 adults (median follow-up, 16.6 months) with and 377 without (control group) PCs treated between 1999 and 2018 at Chang Gung Memorial Hospital. All PCs were diagnosed/confirmed by psychiatrists through face-to-face interviews.ResultsThe PCs predicted serious esophagogastroduodenoscopy grading, higher rates of admission/surgery/intensive care unit stay, increments of systemic/gastrointestinal complications, and poorer 5-year overall survival rates. The poor survival among patients with PCs was highly consistent with their baseline characteristics. Significantly advanced age, more non-PCs, alcoholism, illicit drug abuse, and baseline unhealthy status resulted in statistically higher risks of severe complications and limited recovery.ConclusionPCs changed clinical patterns and had critical roles in the survival outcomes of caustic injury victims. Clinical awareness achieves benefit by limiting injuries in mild cases or allowing emergent interventions in severe cases. Future studies based on worldwide populations are essential for realizing geographic differences.

Brain Abscess and Esophageal Dilatation: Where is the Link? - Case Report

Abstract Introduction Caustic substance ingestion is a common cause of esophageal stricture in children. The primary treatment is esophageal dilatation. Although it is known that endoscopic esophageal dilatation is a procedure associated with a high rate of bacteremia, current guidelines do not recommend routine throat swab cultures or antibiotic prophylaxis for the general children population. Case Report We describe a case of a 7-year-old boy presenting with refractory headaches who was diagnosed with cranial abscess after multiple esophageal dilatations due to stenosis caused by caustic soda ingestion. The patient was subjected to neurosurgical intervention and intravenous antibiotic treatment for 6 weeks. Streptococcus viridans culture was positive in purulent abscess content. Conclusion We highlight this condition that, although rare, needs immediate diagnosis and proper treatment. We also recommend routine testing of throat swabs and antibiotics prophylaxis to children undergoing esophageal dilatation.