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Endoscopic Grading as a Predictor to Develop Strictures in Corrosive Esophagitis in Children
Ioana Badiu Tisa1,2, Lia Pepelea3, Alexandru Pirvan2,4
1Department of Mother and Child, Pediatric Clinic III, Iuliu Hatieganu University of Medicine and Pharmacy, 400217 Cluj-Napoca, Romania.
Insights
Corrosive esophagitis in children is increasingly reported globally. This study found that endoscopic grading predicts strictures, with grades 2B and 3A being high-risk, emphasizing the need to prevent malnutrition.
Area of Science:
- Pediatric Gastroenterology
- Toxicology
- Endoscopic Medicine
Background:
- Corrosive esophagitis incidence is rising in developing nations.
- Acids and alkalis are key factors in pediatric corrosive esophagitis.
- This study investigates incidence and endoscopic grading in a pediatric cohort.
Purpose of the Study:
- To determine the incidence of corrosive esophagitis in children.
- To establish the correlation between endoscopic grading and late complications.
- To identify risk factors for stricture formation.
Main Methods:
- Retrospective analysis of pediatric patients with corrosive ingestion.
- Data collected over a 10-year period from a single center.
- Endoscopic grading used to assess injury severity.
Main Results:
- 22 pediatric patients analyzed; 59.09% were girls.
- Laboratory tests showed poor correlation with injury severity.
- Grades 2B and 3A esophagitis were associated with strictures (60.60% of cases).
- Pro-inflammatory cytokines (IL-2, IL-5, Interferon-gamma) were elevated.
- Malnutrition and prolonged hospitalization were common in severe cases (Grade 3A).
Conclusions:
- Corrosive esophagitis incidence is low in the studied region.
- Endoscopic grading effectively predicts the likelihood of strictures.
- Grades 2B and 3A esophagitis necessitate close monitoring for stricture development.
- Preventing strictures and malnutrition is critical for patient outcomes.
Introduction:
The incidence of corrosive esophagitis, also known as caustic esophagitis in children, is still increasing in developing countries, according to different clinical reports. Acids and alkalis are, in the same manner, involved in the pathogenesis of corrosive esophagitis in children. The aim of our study was to determine the incidence and endoscopic grading of corrosive esophagitis in a cohort of children from a developing country.
Materials And Methods:
We performed a retrospective analysis of all pediatric patients who were admitted for corrosive ingestion at Pediatric Clinic II, Emergency Hospital for Children, Cluj-Napoca, over 10 years.
Results:
A total of 22 patients consisting of 13 (59.09%) girls and 9 boys (40.91%) were found in the present research. The majority of children lived in rural areas (69.2%). The results of laboratory tests were not well correlated with the degree of the injury. White blood cell counts over 20,000 cells/mm3, an increase in the C-reactive protein level and hypoalbuminemia were noticed only in three patients with strictures. The lesions were associated with increased levels of the pro-inflammatory cytokines, including interleukin (IL)-2, IL-5 and Interferon-gamma. Severe late complications such as strictures have been noticed in children with grade 3A injuries. The endoscopic dilation was done after the six months endoscopy. None of the patients treated with endoscopic dilation required surgical intervention for esophageal or pyloric perforation or dilation failure. The majority of complications (such as malnutrition) were noticed in children with grade 3A injuries. In consequence, prolonged hospitalization has been required. The second endoscopy (done six months after ingestion) revealed stricture as the most common late complication (n = 13, 60.60%: eight patients with grade 2B and five with grade 3A).
Conclusion:
There is a low incidence of corrosive esophagitis in children in our geographic area. Endoscopic grading is a predictor of late complications such as strictures. Grade 2B and 3A corrosive esophagitis are likely to develop strictures. It is crucial to avoid strictures and to prevent malnutrition.
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