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Caustic strictures of the oesophagus
M G Lee1, M Y Sing, S Venugopal
1Department of Medicine, U.W.I., Jamaica.
Insights
Caustic ingestion, especially in young children, frequently leads to severe esophageal strictures. Prevention through public education and manufacturer safety measures is crucial to avoid these serious injuries.
Area of Science:
- Pediatric Gastroenterology
- Otolaryngology
- Emergency Medicine
Background:
- Ingestion of caustic substances presents a significant clinical challenge, disproportionately affecting children.
- Caustic ingestion can lead to severe esophageal burns and long-term complications.
Purpose of the Study:
- To report on the clinical features, management, and outcomes of patients with caustic ingestion.
- To highlight the high incidence of esophageal strictures in pediatric patients following caustic ingestion.
Main Methods:
- A retrospective review of 25 patients treated for caustic ingestion over a ten-year period.
- Analysis of patient demographics, presenting symptoms, burn severity, stricture location, and treatment modalities.
Main Results:
- Twelve patients (48%) developed severe esophageal burns and strictures, with ten being children under six years old.
- Dysphagia and vomiting were the predominant symptoms; oropharyngeal burns were noted in 83% of those with esophageal involvement.
- Treatment included periodic dilatations (successful in 7 patients) and surgery (required in 5 patients).
Conclusions:
- Caustic ingestion is a preventable cause of severe esophageal damage, particularly in young children.
- Public education and improved safety measures by manufacturers are essential to reduce the incidence of caustic ingestion injuries.
Abstract:
Ingestion of caustic material is a major management problem which occurs most commonly in children. Twenty-five patients with caustic ingestion seen over a ten-year period are reported. Twelve patients had severe burns, resulting in oesophageal strictures. Of these, ten were children below six years of age (median age, 3 years). Dysphagia and vomiting were the main presenting features. Oropharyngeal burn was present in 83% of patients with oesophageal burns. The strictures involved the entire oesophagus in two patients, the upper third in four, the mid oesophagus in two and the lower third in four. Periodic dilatations were successful in restoring an adequate lumen in 7 patients with short strictures. Five patients required surgery. There was one death. Caustic damage to the oesophagus is preventable. Education of the public and simple measures by manufacturers of caustics are urgently needed.