Orocecal transit time in patients in the chronic phase of corrosive injury

Accidental/suicidal ingestion of corrosive substances is common in North India. Decreased gastric secretion and delayed gastric emptying in the chronic phase of corrosive injury has been documented at our center. We hypothesize that patients in the chronic phase of corrosive injury may have delayed orocecal transit time (OCTT).

To measure the orocecal transit time (using the noninvasive method of lactulose hydrogen breath test) in patients in the chronic phase of corrosive injury.

Thirty patients with corrosive injury to their gastrointestinal tract with its sequelae and attending the gastroenterology services of PGIMER, Chandigarh for endoscopic dilatation of strictures were enrolled in this study. Patients with age >60 years, vagotomy, prior gastric surgery, peptic ulcer disease, systemic sclerosis, history of diabetes, hypothyroidism or intestinal pseudo-obstruction were excluded. Orocecal transit time was measured by using a 15 mL lactulose hydrogen breath test. End expiratory breath was taken every 10 min until there was a rise >10 ppm over the fasting value in two consecutive readings.

Thirty patients (11 females and 19 males) with a median age of 32 years, 27 with acid ingestion and 3 with alkali ingestion, were studied. None had symptoms of gastric outlet obstruction or gastroparesis. OCTT was significantly prolonged in the study group as compared to the control group (135.4 +/- 15.8 versus 90.6 +/- 10.4 min). No significant difference was observed between different age groups, gender, and type of caustic agent consumed. OCTT was maximally prolonged in patients with involvement of lower oesophagus, whereas patients without lower oesophagus involvement did not show significantly altered OCTT.

Our results show that patients with corrosive injury have prolonged OCTT even in the absence of any gastric symptoms. OCTT was prolonged maximally in patients with lower-third oesophageal cicatrization. This may a result of autovagotomy due to vagal entrapment in the cicatrization process involving the lower third of oesophagus.