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Caustic Ingestion in Children: 1 Year Experience in 3 Italian Referral Centers
Giovanni Di Nardo1, Pietro Betalli2, Maria Teresa Illiceto3
1NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome.
Insights
Caustic ingestion in children is a serious issue. Alkaline agents cause worse outcomes than acid agents, and symptoms predict esophageal injury, guiding treatment decisions.
Area of Science:
- Pediatric Gastroenterology
- Toxicology
- Emergency Medicine
Background:
- Caustic ingestion in children remains a significant medical concern despite prevention efforts.
- Understanding clinical consequences and prognostic factors is crucial for effective management.
Purpose of the Study:
- To evaluate clinical outcomes of caustic ingestion in pediatric patients.
- To identify prognostic factors influencing diagnostic and therapeutic strategies.
Main Methods:
- Retrospective analysis of 44 children with caustic ingestion (June 2017-June 2018).
- Review of medical records, laboratory results, and endoscopic findings.
- Comparison of outcomes based on ingested agent (alkaline vs. acid) and symptom presence.
Main Results:
- Alkaline agents were ingested by 59.1% of patients, associated with worse endoscopic scores and higher stricture risk.
- Acid agents were ingested by 40.9% of patients.
- Risk of severe esophageal lesions increased with symptom severity; asymptomatic patients had no esophageal injury.
Conclusions:
- Endoscopic evaluation is essential for symptomatic children to guide treatment.
- Asymptomatic children, especially with suspected ingestion and no oropharyngeal burns, may not require endoscopy.
Objectives:
Despite the efforts to reduce the exposure to corrosive household products, caustic ingestion in children is currently a significant medical problem. The aims of the present study were to evaluate the clinical consequences of caustic ingestion and to identify prognostic factors that could concur in driving both diagnostic and therapeutic management.
Methods:
All consecutive children referred for ingestion of a caustic substance from June 2017 to June 2018 were enrolled. Medical records, laboratory and endoscopic findings were reviewed and analyzed.
Results:
We enrolled 44 children with caustic ingestion. Alkaline agents were ingested by 26 of 44 (59.1%) patients, whereas acid agents were ingested by 18 of 44 patients (40.9%). Alkaline rather than acid agents were associated with a worse endoscopic score (r: 0.45) and a higher probability of early esophageal stricture occurrence (r: 0.38). The specific risk of the presence of severe esophageal lesions rose progressively with increasing number of symptoms whereas no esophageal injury was found in asymptomatic patients.
Conclusions:
Our data suggest that endoscopic evaluation is mandatory in symptomatic patients to direct therapeutic management, but it could be avoided in asymptomatic patients after accidental ingestion, particularly if the ingestion is only suspected and patients have no oropharyngeal burns.
