Severe Caustic Injury Research Articles

Long-term outcomes of patients undergoing emergency surgery for corrosive injury of the upper digestive tract.

Emergency surgery can save patients' lives in cases of severe caustic injury. However, the long-term outcomes are not well understood. Patients who underwent emergency organ resection for severe corrosive acid injury were included. Subsequently, digestive tract reconstruction was performed to fit patients. Long-term outcomes were analyzed. Fifty patients underwent emergency digestive tract resection. The operative mortality rate was 6% (of 3/50). One of the 50 patients underwent successful immediate reconstruction. Of the 46 survivors with digestive tract discontinuity, 32 (70%) underwent subsequent reconstructive surgery, 10 (22%) died while awaiting reconstruction due to deterioration in their psychiatric and nutritional status, and 4 (9%) were unfit for reconstructive surgery. No operative mortality occurred during reconstruction. Among the 32 patients who underwent reconstruction, 30 (94%) achieved nutritional autonomy. Nutritional independence was achieved in 62% of the patients (31/50). At a median duration of 58months, the median survival time of the 50 patients was 158months. Patients who underwent reconstruction had a significantly better overall survival than those who did not (p < 0.0001). Emergency surgery remains the standard treatment for corrosive ingestion of complicated digestive tract injuries. However, only 60% of survivors can undergo subsequent digestive reconstruction and achieve long-term nutritional autonomy and a survival outcome.

Can we predict the risk of esophageal stricture after caustic injury?

Nonoperative management of severe caustic injuries has demonstrated its feasibility, avoiding the need for emergency esogastric resection and resulting in low mortality rates. However, leaving superficial necrosis in place could increase the risk of esophageal stricture development. Data on the risk factors of esophageal stricture secondary to caustic ingestion are scarce. The aim of our study was to identify the risk factors for esophageal strictures after caustic ingestion at admission. From February 2015 to March 2021, all consecutive patients with esophageal or gastric caustic injury score ≥ II according to the Zargar classification were retrospectively analyzed. For each patient, we collected over 50 criteria at admission to the emergency room and then selected among them 20 criteria with the best clinical relevance and limited missing data for risk factor analyses. Among the 184 patients included in this study, 37 developed esophageal strictures (cumulative rate 29.4%). All esophageal strictures occurred within 3months. In multivariate analyses, the risk factors for esophageal strictures were voluntary ingestion (cause-specific hazard ratio 5.92; 95% confidence interval 1.76-19.95, P = 0.004), Zargar's esophageal score ≥ III (cause-specific hazard ratio 14.30; 95% confidence interval 6.07-33.67, P < 0.001), and severe ear, nose, and throat lesions (cause-specific hazard ratio 2.15; 95% confidence interval 1.09-4.22, P = 0.027). Intentional ingestion, severe endoscopic grade, and severe ENT lesions were identified as risk factors for esophageal stricture following caustic ingestion. Preventive measures for this population require further evaluation.

Man Presenting After Hydrochloric Acid Ingestion.

We describe a case of a man who developed severe caustic injury of his upper gastrointestinal tract after ingestion of a commercially available 9.5% hydrochloric acidic cleaning solution. He rapidly deteriorated and required endotracheal intubation. He underwent several imaging modalities demonstrating his injuries and ultimately succumbed to his injuries. Acidic caustic ingestions may range in severity and uncommonly result in death. Diagnosis is most often achieved by esophagogastroduodenoscopy, although computed tomography may increasingly play a role in defining the extent of injury. Esophagogastroduodenoscopy findings are often assigned a Zargar grade, which guides management. Medical management of acidic caustic ingestion may include bowel rest, steroids, antibiotics, and proton pump inhibitors depending on the extent of injury, although surgery may be required if esophageal perforation occurs.

Management of caustic pharyngoesophageal injuries in Korle Bu Teaching Hospital, Accra, Ghana: a 12-year retrospective review of 29 cases.

caustic pharyngoesophageal strictures are life-threatening injuries with important management difficulties, lacking clear therapeutic guidelines. The aim of this study is to evaluate the surgical procedures and outcomes of severe caustic pharyngoesophageal strictures in our institution. a total of 29 patients who underwent surgery for severe caustic pharyngoesophageal injury at the National Cardiothoracic Center from June 2006 to December 2018 were retrospectively reviewed. The age distribution, sex, management procedures, complications after surgery, and the outcome were analyzed. there were 17 males. The mean age was 11.7 years (range 2- 56 years). All patients accidentally swallowed caustic soda, except the oldest patient who ingested an unidentified substance. The treatment procedures included colopharyngoplasty in 15 (51.7%) patients, colon-flap augmentation pharyngoesophagoplasty (CFAP) in 10 (34.5%), and colopharyngoplasty with tracheostomy in 4 (13.8%). There was one case of graft obstruction from a retrosternal adhesive band and one case of postoperative reflux with nocturnal regurgitation. No cervical anastomotic leak occurred. Rehabilitative training for oral feeding was required for less than a month in most patients. Follow-up period ranged from one to twelve years. Four patients died within this period; two were immediate post-operative deaths and two occurred late. One patient was lost to follow-up. outcome of surgery for caustic pharyngoesophageal stricture is satisfactory. Colon-flap augmentation pharyngoesophagoplasty reduces the need for tracheostomy before surgery, and our patients start eating early without aspiration.

Mo1048 POOL DAY GONE WRONG. A CASE OF CAUSTIC INJURY CAUSED BY HYDROCHLORIC ACID IN POOL CLEANER

Caustic injuries to the gastrointestinal tract usually occur after the ingestion of strong acidic or basic solutions, which can penetrate and necrose the mucosal lining. 80% of cases are reported to occur in children and usually caused by accidental ingestion. Although more rare, caustic ingestion in adults tend to be intentional and more severe. Here, we report an interesting case of a male patient with acid ingestion causing severe caustic injury.

Mucosal healing after high dose pantoprazole in acute corrosive injury of esophagus

INTRODUCTION : The ingestion of corrosive agents is still an important public health issue in our country. The GIT injuries caused by caustic agents can range from minor to fatal, or can lead to chronic disease with poor quality of life. Corrosive agents with a pH level less than two or more than twelve can rapidly penetrate the layers of the oesophagus and result in necrosis and scar formation in the mucosa. Acidic agents produce coagulation necrosis and eschar formation that may limit tissue penetration and may even spare the oesophagus when the transit is rapid. On the other hand, Alkaline agents when ingested produce liquefaction necrosis and can cause serious oesophageal injury by penetrating to deep muscle layers. The basic histopathologic reaction of tissue subjected to caustic burn is the synthesis, deposition and remodelling of collagen. Following full-thickness injuries to the oesophageal wall, the normal oesophagus is replaced by dense connective tissue. Collagen overproduction has been estimated to cause stenosis in half of the patients suffering severe burns. Consequently, when treating caustic burn injuries, it is necessary to prevent stenosis by inhibiting collagen synthesis or changing the properties of the deposited collagen. The optimal management protocol in the treatment of severe caustic injury remains controversial. The main goal of medical treatment is to inhibit inflammatory reaction or stricture formation secondary to oesophageal burning. Stricture formation is thought to be overcome by suppressing fibroplasia and scarring. Many agents directed at wound healing and stricture prevention have been used in several experimental studies in past. Results of such treatment protocols including steroids, antibiotics, heparin, indomethacin, sucralfate, vitamin E, as well as total parenteral nutrition are all controversial in treatment of corrosive burns. Randomised control trials on the role of proton pump inhibitors in caustic injuries of GIT are lacking. A few experimental studies have investigated the relationship between proton pump inhibitors and corrosive burns and has shown that proton pump inhibitors can reduce inflammation in early phase of caustic injury. Proton pump inhibitors, by decreasing gastric acid secretion and thereby GER can prevent worsening of corrosive injury. In addition proton pump inhibitors has also been shown to have anti-inflammatory and antioxidant properties. A prospective study from turkey on 13 patients have showed that omeprazole can be used effectively in treatment of acute corrosive injury of esophagus. There are no studies from India which have attempted to assess the usefulness of proton pump inhibitors in treatment of acute corrosive injury of esophagus. This prompted us to study the usefulness of pantoprazole in the treatment of patients presenting with acute corrosive injury of the oesophagus. AIM OF THE STUDY : To study the efficacy of high dose pantoprazole in causing mucosal healing after acute corrosive injury of esophagus. CONCLUSION : Treatment of corrosive injury is controversial and there are no definitive protocols. Intravenous proton pump inhibitors are widely used in treatment of corrosive injuries despite lack of evidence. Our study has demonstrated that effective mucosal healing can be achieved by intravenous proton pump inhibitor infusion. Though majority of patients in our study had minor grade of injury, 27% of the patients included in the study had 2b and 3a injury. When analysis is confined to these patients, 53% showed improvement by 1 grade, 33.3% showed improvement by 2 grades and 13.3% did not show improvement. Therefore it is evident from above that high dose pantoprazole is also beneficial in patients with higher grade of injury and may prevent late complications in these patients. A larger randomised placebo controlled trial in patients with higher grade of oesophageal injury is needed to determine if high dose pantoprazole should form standard of care in treatment of patients with acute corrosive injury of oesophagus.

Esophagectomy with gastric conduit reconstruction for benign disease: extreme but important.

Esophagectomy is usually performed to resect esophageal cancer. However, there are numerous other indications for esophagectomy, including Barrett's esophagus with high-grade dysplasia (HGD) and some benign diseases such as obstruction, end-stage achalasia, esophagus perforation or disruption, benign neoplasm, and severe caustic injury. For these patients, esophagectomy could relieve their symptom obviously. However, esophagectomy causes huge trauma, induces quite high morbidity and mortality, and may decreases patients' quality of life obviously due to postoperative reflux, dumping, anastomotic stricture and other complications. Accordingly, the considerations of a surgery must be carefully deliberated, including the underlying disorder, lesions localization, extent of disease, and options for esophageal replacement. For patients received esophagectomy and alimentary tract reconstruction, gastric conduit is the most common used replacement organ, then colon and jejunum. This review demonstrated the importance and technical experience of esophagectomy with gastric conduit reconstruction for benign diseases.

The Role of Second-look Endoscopy in Severe Esophageal Caustic Injury

Severe caustic ingestion often leads to multiple complications and high mortality rate. Esophagogastroduodenoscopy is recommended during the first 24 hours for severity and extent evaluation, but it seems insufficient to guide further managements in severe caustic injury patients due to rapid progression and variable clinical conditions. Therefore, we tried to evaluate the safety and role of second-look endoscopy in these patients in 1-2 weeks later. We retrospectively collected severe esophageal caustic injury (grade 2b, 3a, 3b) adults with and without secondlook endoscopy in subacute stage (6th-14th days after caustic injury) in Linkou Change Gung Memorial Hospital during 2011/1-2014/11. They were divided in to once endoscopy group and second-look endoscopic group according to the patients with second-look endoscopy or not. They were further matched with the same cause of caustic injury, corrosive properties, injury grading, and then selected with Excel RAND function. There were 26 patients in both groups. The average timing of second-look endoscopy was 10.23 ± 3.166 (mean ± SD) days after caustic ingestion. The hospital stay was significantly shorter in the second-look endoscopy group (24.92 ± 17.50 days, 54.38 ± 43.73 days, P=0.002). However, the complication rate was not statistically significant between these two groups. In conclusion, second-look endoscopy is safe and might shorten the hospital stay. However, prospective, randomized and larger sample size studies are needed to support the finding.

Conservative management of severe caustic injuries during acute phase leads to superior long-term nutritional and quality of life (QoL) outcome.

Best clinical management of severe caustic injury is still a subject of debate. Most surgical teams consider severe caustic injury as an indication for emergency surgery. But, under certain circumstances, conservative management is feasible, avoids the need for gastrectomy, and has a low mortality rate. Postponed reconstructive surgery is usually performed several months after caustic ingestion to restore intestinal continuity or to treat stricture sequelae. This study aimed to investigate long-term nutritional and quality of life (QoL) outcomes after reconstructive surgery for high-grade esophageal and gastric caustic injury. Twenty-one patients were assessed for biological and nutritional parameters, physical findings, and quality of life surveys at least 25 months after reconstructive surgery among patients who have required emergency surgery (n = 10) and patients who did not undergo emergency surgery (n = 11). After median follow-up of 74 months (after caustic ingestion) and 67 months (after reconstructive surgery), patients who avoided emergency surgery experienced faster oral diet resumption (49 vs. 157 days, p = 0.004), less weight loss (0.3 vs. 20 kg, p = 0.002), greater body fat percentage (22 vs. 18 %, p = 0.046), better nutritional and physical status (SF12 PCS 51 vs. 43, p = 0.036), and less trouble eating (EORTC QLQ-OG 25 31 vs. 56, p = 0.01). Our study is the first to evaluate long-term nutritional and QoL outcomes, following severe caustic injury. It demonstrates better long-term nutritional outcomes and QoL in patients suitable for initial conservative management. These results support full functional recuperation of spared organs, even severely burned. In the absence of clinical or biological signs necessitating immediate surgery, conservative management should be advocated.

Predicting the progress of caustic injury to complicated gastric outlet obstruction and esophageal stricture, using modified endoscopic mucosal injury grading scale.

Severe caustic injury to the gastrointestinal tract carries a high risk of luminal strictures. The aim of this retrospective study was to identify predicting factors for progress of caustic injury to gastric outlet obstruction (GOO) and esophageal strictures (ES), using modified endoscopic mucosal injury grading scale. We retrospectively reviewed medical records of patients with caustic injuries to the gastrointestinal tract in our hospital in the past 7 years. We enrolled 108 patients (49 male, 59 female, mean age 50.1 years, range 18–86) after applying strict exclusion criteria. All patients received early upper gastrointestinal endoscopy within 24 hours of ingestion. Grade III stomach injuries were found in 58 patients (53.7%); 43 (39.8%) esophageal, and 13 (12%) duodenal. Of the 108 patients, 10 (9.3%) died during the acute stage. Age over 60 years (OR 4.725, P = 0.029) was an independent risk factor of mortality for patients after corrosive injury. Among the 98 survivors, 36 developed luminal strictures (37.1%): ES in 18 patients (18.6%), GOO in 7 (7.2%), and both ES and GOO in 11 (11.3%). Grade III esophageal (OR 3.079, P = 0.039) or stomach (OR 18.972, P = 0.007) injuries were independent risk factors for obstructions. Age ≥60 years was the independent risk factor for mortality after corrosive injury of GI tract. Grade III injury of esophagus was the independent risk factor for development of ES. Grade III injury of stomach was the independent risk factor for development of GOO.

Gastrocele Complicates the Course of Non‐operated Severe Caustic Injuries: Operative Strategies

For selected cases of severe caustic injuries, evidence favors conservative management, consisting of radiographic and clinical observation without emergency surgery. However, this approach can lead to the development of gastric distension caused by combined esophageal and antral strictures, called gastrocele. This study assessed the safety of a two-stage surgical treatment for gastrocele. Patients treated in our department between 2004 and 2010 for caustic injury who did not receive emergency surgery and subsequently developed gastrocele were retrospectively analysed. Demographic information, symptoms, and ingestion history were documented. Surgical management included partial gastrectomy and postponed esophageal stricture treatment. Outcome measures included postoperative morbidity and mortality. Eight nonoperated patients with severe caustic injury from suicidal ingestions of caustic substances were found to have developed gastrocoele. They presented with mostly endoscopic stage IIIb esophageal and gastric injuries. All patients had clinical symptoms of vomiting and abdominal tenderness at day 8 after caustic ingestion. Antrectomy and esophageal stricture treatment were performed at an average of 2 and 8 months, respectively, after caustic ingestion. There were no postoperative deaths, and the long-term survival rate was 83 %. Gastrocele should be suspected in patients with stage III gastric and esophageal injuries who have been treated by conservative management and are still vomiting more than 1 week postingestion. A two-staged surgical strategy of antrectomy followed by a postponed esophageal stricture treatment was found to be safe and effective for these patients.

A Rare Cause of Caustic Gastric Injury in a Young Man

MAHOMEDY MC, 1975, ANAESTHESIA, V30, P190, DOI 10.1111-j.1365-2044.1975.tb00832.x; MIDDLETON SJ, 1990, POSTGRAD MED J, V66, P657; Young RJ, 1996, HUM EXP TOXICOL, V15, P259

Sa1953 Severe Gastric Caustic Injuries (SGCI) - Conservative Management During Acute Phase Leads to Superior Long-Term Quality of Life (QOL) and Nutritional Outcome

Sa1953 Severe Gastric Caustic Injuries (SGCI) - Conservative Management During Acute Phase Leads to Superior Long-Term Quality of Life (QOL) and Nutritional Outcome

Effects of sodium hydroxide exposure on esophageal epithelial cells in an in vitro ovine model: implications for esophagus tissue engineering

BackgroundEsophagus tissue engineering holds promises for esophageal replacement after severe caustic injuries. The aim of this study was to determine whether viable esophageal epithelial cells could be isolated from an esophagus exposed to varying concentrations of alkali with regard to number, viability, and morphology during in vitro culture. MethodsOvine esophagi were exposed to phosphate-buffered saline 2.5%, 15%, or 25% sodium hydroxide (NaOH). The effect of NaOH concentrations on epithelial damage was assessed histologically. Esophageal epithelial cells were then isolated, and cell count and viability were investigated. Finally, cell number, viability, and morphology of esophageal epithelial cells were determined for 24 days of in vitro culture. ResultsHistologic analysis showed a progressive destruction of the epithelium proportional to increasing NaOH concentrations. Esophagi treated with phosphate-buffered saline and 2.5% NaOH showed significantly higher viable cell counts after isolation and culture in comparison with those treated with 15% to 5% NaOH. ConclusionThe evidence presented in this study indicates that epithelial biopsies from an esophagus exposed to low concentrations (2.5%) of NaOH will still yield large numbers of viable cells suitable for tissue engineering applications. In cases of exposure to higher concentrations (15%-25%), alternative cell sources for epithelial regeneration, such as stem cells, will be necessary for tissue engineering applications.

The Implementation of Laparoscopy for Acute Caustic Gastrointestinal Injuries Is Limited: Reply

To the Editor, We are grateful for the clinical experience and suggestions provided by Dr. Huscher and colleagues concerning their laparoscopic management of caustic injuries to the upper gastrointestinal tract (UGI). Also, we congratulate them on their brilliant results. Minimally invasive surgery such as video-assisted thoroscopic surgery (VATS) and laparoscopy has been performed regularly in our department for more than 10 years. Total minimally invasive esophagectomy and gastric tube reconstruction for esophageal cancer with assist devices, such as the harmonic scalpel and endo-GIA stapler, have also been performed in a certain number of cases. However, the application of endoscopy in emergency surgery for patients with severe caustic UGI injuries remains a contentious issue. The operative indications in our series are listed in our article. Most of our patients underwent operation because of shock or persistent metabolic acidosis despite intensive resuscitation. As you can imagine, clinical conditions (hypotension, acidosis etc.) became even worse during the operation. The only way to save these patients is to remove the necrotic organs and tissue as soon as possible, i.e. to stop the continuous absorption of toxins, which would otherwise cause sepsis. In most cases, we finished resection within 60–90 min. We then irrigated the entire abdominal cavity, using approximately 10,000 ml of warm saline to clear all intraperitoneal soiling and thus prevent postoperative abdominal abscess. The entire anesthesia time should be as short as possible for these patients. The disadvantages of laparoscopic resection that concern us most are: (1) the instillation of carbon dioxide into the peritoneum, further compromising cardiopulmonary function and causing unpredictable intraoperative tragedy; (2) intraperitoneal spillage of gastrointestinal contents due to necrotic perforation—difficult to completely clean up through the endoscope and potentially very time consuming. The operative time achieved by Dr. Huscher was 218 ± 28 min, but is the time used for peritoneal lavage after resection taken into account? We have to point out that one of the main differences in caustic UGI injuries in Western countries and Taiwan is the caustic agent. In Taiwan, acid is the most commonly ingested agent. Unlike the localized lesions caused by ingestion of solid alkaline pellets, the low pH of acid causes diffuse injuries from the midor even upper esophagus down to the gastric body and antrum. This extent of injury greatly increases operative difficulty. We agree that laparoscopy is of value in the management of a limited number of cases of acute caustic GI injuries, provided the patient’s vital signs are stable and there is no perforation. Also, it is a valuable tool for early diagnosis of some cases with equivocal clinical conditions. For the ‘‘very sick patients,’’ as Dr. Huscher has said, what would be more important, a life-saving operation or minimally invasive surgery in order to reduce surgical trauma? Intestinal continuity was restored in two of Dr. Huscher’s young patients; what about the other 4? We appreciate this opportunity to reply to Dr. Huscher’s comments. Also we acknowledge and thank Jadzia Chou for manuscript revision. S.-H. Chou H.-P. Li Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

The Conservative Management of Severe Caustic Gastric Injuries

To determine the safety of a conservative approach to treating severe caustic injury in patients lacking clinical and biochemical signs of transmural necrosis. Esophagogastrectomy is thought to limit the progression of severe caustic injury in the upper gastrointestinal tract observed upon initial endoscopic examination. However, endoscopic evaluation of the depth and spread of necrosis is challenging and may lead to unnecessary gastrectomy. From January 2002 to December 2008, 70 patients were classified as having stage III gastric injury in an initial digestive tract endoscopic examination. When patients had no signs of peritonitis, their treatment was determined by 6 clinical and biochemical factors of severity (abdominal rebound tenderness, neuropsychiatric troubles, cardiovascular shock, metabolic acidosis, disseminated intravascular coagulation, and kidney failure) in addition to endoscopic staging. If one of these clinical and biochemical factors was present, the patient underwent emergency laparotomy. Patients with isolated stage III gastric injury were kept under close observation. Twenty-four of the 70 endoscopic stage III patients required emergency surgery. Conservative treatment was initiated in the remaining 46. There were 4 postoperative deaths (5.7%). Fifteen patients required subsequent surgery: distal gastrectomy with Billroth I anastomosis (n = 7) for distal stricture and esophagoplasty for nondilatable esophageal stricture (n = 8). At the end of the follow-up period, total or partial gastric conservation was achieved in all 46 patients (65.7%) and the esophagus was conserved in 38 patients (54.3%). In the absence of clinical and biological signs of severity, conservative management of stage III gastric injury is clinically feasible, precludes gastrectomy and has a low mortality rate.

A Biodegradable Esophageal Stent in the Treatment of a Corrosive Esophageal Stenosis in a Child

A Biodegradable Esophageal Stent in the Treatment of a Corrosive Esophageal Stenosis in a Child

Severe Caustic Injury

A 32-year-old man presented to the emergency department complaining of difficulty of swallowing. Four weeks ago he swallowed an unknown quantity of a bleaching substance (sodium hypochlorite) by mistake and was admitted to the hospital for three days. A barium swallow via a naso-oesophageal tube was carried out.

Role of Fibrin Glue in the Prevention of Cervical Leakage and Strictures After Esophageal Reconstruction of Caustic Injury

The colon is the organ most commonly used for esophageal reconstruction after severe caustic injury. Complications of cervical anastomosis are very common. Fibrin sealant may reduce the incidence of complications in this high-risk anastomosis. The purpose of the present study was to assess the role of fibrin glue in the prevention of leakage and stricture at cervical coloesophageal anastomoses in children treated with esophageal reconstruction after caustic injury. This was a case-control study of children with caustic esophageal injury treated surgically with esophageal reconstruction over a 10-year period. In the study group 3-4 ml of fibrin glue was placed over the anastomosis. The following variables were assessed: age, sex, weight, leakage or stricture at the cervical anastomosis, morbidity, and mortality. The study group included 14 children, and the control group included 24 children. There were no differences in the distributions of sex, age, anthropometric variables, or preoperative laboratory test results. All children underwent esophageal replacement with colon substitution through the retrosternal space. Dehiscence and leakage at the cervical anastomosis were observed in 50% of children in the control group and 28.5% of children in the study group (P = 0.17). Strictures were observed in 7.15% of the study group and 20.8% of the control group, and 5 and 17 children, respectively, developed cervical complications (P = 0.03). There were no differences in major complications, and mortality was similar in the two groups (P = 0.60). Fibrin glue, when used as a sealant for cervical coloesophageal anastomosis, can reduce the risk of leakage and stricture.

Estudio de los factores predictivos de lesiones digestivas graves tras la ingestión de cáusticos

Our purpose was to analyze the predictive factors of severe upper gastrointestinal injury by caustic substances in adult patients.Retrospective study between February 1995 and February 2001 of adult patients who underwent an urgent upper endoscopy due to caustic ingestion. Endoscopic caustic ingestion criteria by Zargar et al were used to determine the degree of injury. We performed a univariate study of factors associated with sever digestive injury and, lately, a logistic regression analysis of predictive factors. Sensitivity, specificity, positive and negative predictive values of these factors were calculated.One hundred and fifty nine patients were included in the study, whose mean age was 48.9 (20.1) years and 49.7% were men. The more frequent caustic ingested was lye (47.8%). A severe caustic injury was found in urgent upper endoscopy in 18.4% of patients, which was located in esophagus in 14.6%, stomach in 8.2% and duodenum in 0.6% of cases. Male sex, voluntary ingestion, oropharingeal lesions, significant clinical symptoms and dishwasher and detergents ingestion were associated with severe upper gastrointestinal tract (GIT) injury. Voluntary ingestion, oropharingeal lesions and significant clinical symptoms at admission were independent predictive factors of severe GIT injury. The existence of one of these factors had an 89.7% of sensitivity while two or more displayed a specificity of 91%.Clinical and exploratory data may determine, before upper endoscopic procedure, the probability of severe GIT injury by caustic ingestion. Therefore, these data could play a significant role in the diagnostic, prognostic and therapeutic management of caustic ingestion.