Steroids have been widely used to prevent the severe secondary strictures that inevitably follow accidental ingestion of caustic substances by children, though with controversial results. To confirm the efficacy of large early doses of dexamethasone, we conducted an experimental study in rabbits. A cotton swab soaked in sodium hydroxide was placed on the esophageal mucosa of 30 rabbits. The rabbits were then treated with antibiotics and randomly allocated to one of three groups. One group received no steroids; the second group was treated with prednisolone; and the third was given dexamethasone. After 21 days, the rabbits were killed and the severity of the lesion was evaluated by radiological, anatomical, and histological examination. Rabbits with moderate or severe stricture, as defined on the basis of radiological examination, made up 80% of the control group, 70% of the prednisolone-treated group, and 40% of the dexamethasone-treated group. Rabbits with third-degree burns, with or without macroscopic ulcers, made up 60% of the control group, 40% of the prednisolone-treated group, and 30% of the dexamethasone-treated group. On histological examination, rabbits with third-degree lesions made up 70% of the control group, 40% of the prednisolone-treated group, and only 20% of the dexamethasone-treated group. Only the difference between the control and dexamethasone-treated group was statistically significant. Taken together, our results clearly indicate that, in rabbits, rapid postburn administration of dexamethasone leads to significant reductions in the frequency and severity of strictures and in the severity of burns.

We compared the efficacies of prednisolone and dexamethasone for treatment of children with oesophageal burns due to ingestion of caustic substances. The criteria of efficacy used were a) stricture severity by 3 weeks post-ingestion, b) reduction in burn severity by 3 weeks post-ingestion and c) number of dilatations required over the first year post-ingestion. Thirty-six children (24 boys and 12 girls; mean age 23.6 +/- 7.4 months) were selected from a total of 63 patients admitted over a ten-year period to the General Hospital of Galicia with second- or third-degree oesophageal burns due to accidental ingestion of liquid alkali preparations. The patients were divided into two groups of 18, one group for treatment with prednisolone (2 mg/kg/day) and the other for treatment with dexamethasone (1 mg/kg/day). Strictures developed in 12 (66.7%) of the children in the prednisolone-treated group and only 7 (38.9%) of the children in the dexamethasone-treated group. Severe strictures developed in 10 (55.6%) of the children in the prednisolone-treated group and only 5 (27.8%) of the children in the dexamethasone treated group. However, there was no significant difference between the groups in the posttreatment distribution of stricture-severity ratings. Burn healing was significantly better in the dexamethasone-treated group. Similarly, the number of dilatations necessary during the first year of treatment was significantly lower in the dexamethasone-treated group. Our results thus indicate that, by comparison with prednisolone, dexamethasone leads to improved burn healing and reduced need for dialatations during the first year post-injury.

No abstract