[Severe caustic esophagitis in childhood]

A retrospective analysis of patients treated for serious caustic esophagitis in our hospital was performed with the aim of defining epidemiological factors, initial treatment and therapeutic criteria for esophageal stricture with long evolution.

Thirty-four cases of serious caustic esophagitis treated since 1982 were analyzed surveying epidemiologic, clinical and endoscopy data, as well as initial medical treatment, dilatation session number, treatment period, complications, surgical treatment indications if necessary and actual situation.

Alkaline caustic agents were swallowed in 71% of the cases, with dishwashing detergent being the most frequent (16 patients), Grade II esophagitis was noticed in 13 cases, grade III in 18. Established esophageal stricture was present in 3 patients when admitted. Repeated esophageal dilations were necessary in 13 patients (38%), with between 1 and 21 dilatation sessions needed. Esophageal stricture persistence forced us to perform an esophageal substitution technique by esophagocoloplasty. Resection and enlargement of a short stenotic segment was performed in 1 patient. Long-term evolution in all cases has been satisfactory.

We consider that adequate treatment of these patients includes conservative corticosteroids, sucralfate and anti-H2 combined with a previous endoscopy evaluation. If evolution turns into stricture, dilatations must be done, sometimes throughout years. If this treatment fails and the injury is extensive, esophagocoloplasty is the surgical technique of choice. Nevertheless, as any accident, the best treatment is good prevention.