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[Severe caustic esophagitis in childhood]
J Elías Pollina1, M Ruiz de Temiño Bravo, J A Esteban Ibarz
1Servicio de Cirugía Pediátrica, Hospital Infantil Miguel Servet.
Anales Espanoles De Pediatria
|May 15, 1998
Summary
Serious caustic esophagitis, often caused by alkaline agents like dishwashing detergent, requires long-term management. Esophageal strictures may necessitate repeated dilations or, in severe cases, esophagocoloplasty for satisfactory outcomes.
Area of Science:
- Gastroenterology
- Toxicology
- Surgical Gastroenterology
Context:
- Caustic esophagitis is a severe injury to the esophagus.
- Alkaline substances are common causes of caustic ingestion.
- Esophageal stricture formation is a significant long-term complication.
Purpose:
- To define epidemiological factors, initial treatment, and therapeutic criteria for esophageal stricture in patients with severe caustic esophagitis.
- To analyze treatment outcomes and identify surgical indications.
Summary:
- A retrospective analysis of 34 patients with severe caustic esophagitis revealed alkaline agents, particularly dishwashing detergent, as the primary cause.
- Grade II and III esophagitis were common, with 3 patients presenting with pre-existing strictures.
- While 38% required repeated dilatations (1-21 sessions), long-term outcomes were satisfactory, with esophagocoloplasty used in refractory cases.
Impact:
- This study highlights the importance of timely endoscopic evaluation and a multimodal treatment approach including corticosteroids, sucralfate, and anti-H2 therapy.
- It underscores that prolonged dilatations may be necessary for stricture management.
- Esophagocoloplasty is presented as a viable surgical option for extensive, treatment-resistant injuries, emphasizing prevention as the best strategy.