Caustic ingestions. Pathophysiology, diagnosis, and treatment

Area of Science:

• Gastroenterology
• Toxicology
• Emergency Medicine

Background:

• Over 5,000 caustic ingestions occur annually, with liquid lye posing the highest risk of morbidity.
• Clinical signs and symptoms of caustic ingestion are unreliable indicators of injury severity.
• Endoscopic evaluation is the gold standard for assessing the extent of esophageal and gastric injury.

Purpose of the Study:

• To highlight the diagnostic limitations of clinical presentation in caustic ingestions.
• To emphasize the prognostic implications of burn depth and extent.
• To underscore the critical role of prevention in mitigating caustic ingestion morbidity.

Main Methods:

• Review of estimated annual caustic ingestion cases.
• Analysis of clinical signs and symptoms versus endoscopic findings.
• Evaluation of treatment outcomes based on burn severity.

Main Results:

• Clinical indicators like vomiting, dysphagia, and abdominal pain are poor predictors of injury.
• Endoscopy is essential for accurate injury assessment.
• Less severe burns treated with antibiotics and steroids have a good prognosis.
• Deep or circumferential burns carry a high risk of stricture and perforation.
• Lye burn survivors face a significantly elevated risk (1,000-fold) of esophageal carcinoma.

Conclusions:

• Accurate assessment of caustic ingestion severity relies solely on endoscopy.
• Prognosis varies significantly with burn depth, with deep burns leading to severe complications.
• The long-term risk of esophageal cancer following lye burns is substantially increased.
• Prevention strategies are critical to reduce the incidence and impact of caustic ingestions.