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Current practices in the management of corrosive ingestion in children: A questionnaire-based survey and
Rishi Bolia1, Moinak Sen Sarma2, Vishnu Biradar3
1Division of Paediatric Gastroenterology, Department of Paediatrics, All India Institute of Medical Sciences, Rishikesh 249 203, India.
Insights
Accidental corrosive ingestion in children, primarily aged 2-5, lacks standard management guidelines. This survey highlights current practices and proposes an evidence-based algorithm for improved pediatric care.
Area of Science:
- Pediatric Gastroenterology
- Toxicology
- Emergency Medicine
Background:
- Corrosive ingestion in children presents a significant clinical challenge with no established management guidelines.
- Accidental ingestion, often due to improper storage of corrosive substances, predominantly affects children aged 2-5 years.
Purpose of the Study:
- To survey current practices of Indian gastroenterologists in managing corrosive ingestion among children.
- To identify gaps in the evaluation and management of corrosive ingestion.
- To propose a practical management algorithm for corrosive ingestion.
Main Methods:
- An online survey with 65 questions was administered to Indian gastroenterologists.
- Management options were considered 'agreed upon' if endorsed by at least 50% of respondents.
- Data from 98 gastroenterologists (72 pediatric) managing approximately 2600 cases were analyzed.
Main Results:
- Agreement was reached on 77% of survey questions, with consensus on early endoscopy and chest X-ray regardless of symptoms.
- Endoscopy was deemed safe within the first 5 days post-ingestion.
- Consensus supported acid suppression (59%) and antibiotics if indicated (59%), while steroids were generally not recommended (68%). Feeding decisions were based on endoscopic findings, with nasogastric tube placement often guided by endoscopy.
- Disagreement persisted regarding the duration of acid suppression and specific protocols for stricture management.
Conclusions:
- Corrosive ingestion is a common, largely accidental event in young children, preventable by safe storage and labeling.
- A proposed management algorithm aims to standardize care, though areas like long-term acid suppression and refractory stricture management require further consensus.
Background And Aim:
Corrosive ingestion causes significant morbidity in children with no standard guidelines regarding management. This survey aimed to understand practices adopted by gastroenterologists, identify lacunae in evaluation and management and suggest a practical algorithm.
Methods:
Indian gastroenterologists participated in an online survey (65 questions) on managing corrosive ingestion. When ≥ 50% of respondents agreed on a management option, it was considered as 'agreement'.
Results:
Ninety-eight gastroenterologists (72 pediatric) who had managed a total of ~ 2600 corrosive ingestions in the last 5 years responded. The commonest age group affected was 2-5 years (61%). Majority of ingestion was accidental (89%) with 80% due to improper corrosive storage. Ingestion of alkali and acid was equally common (alkali 41%, acid 39%, unknown 20%). History of inducing-vomiting after ingestion by community physicians was present in 57%. There was an agreement on 77% of questions. The respondents agreed on endoscopy (70%) and chest X-ray (67%) in all, irrespective of symptoms. Endoscopy was considered safe on days 1-5 after ingestion (91%) and relatively contraindicated thereafter. The consensus was to use acid suppression, always (59%); steroids, never (68%) and antibiotics, if indicated (59%). Feeding was based on endoscopic findings: oral in mild injuries and nasogastric (NG) in others. Eighty percent placed a NG tube under endoscopic guidance. Stricture dilatation was considered safe after 4 weeks of ingestion. Agreement on duration of acid suppression and stricture management (dilatation protocol and refractory strictures) was lacking.
Conclusion:
Corrosive ingestion mostly affects 2-5-year olds and is accidental in majority. It can be potentially prevented by proper storage and labelling of corrosives. An algorithm for management is proposed.
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