Assessing the Degree of Acute Esophageal Injury Secondary to Corrosive Intake: Insights From a Public Sector Hospitals of a Developing Country

Abstract

Background Caustic ingestion continues to be a significant problem worldwide especially in developing countries and particularly in the age group of under six years. Ingestion of caustic substances is a medical emergency in both the adult and pediatric population and is associated with high morbidity and mortality. The ingestion of caustic substances induces an extensive spectrum of injuries to the aerodigestive tract, which includes extensive necrosis and perforation of the esophagus and stomach. Objectives The main aims were to determine upper and lower esophageal injuries associated with corrosive intake and to compare esophageal injury with age and gender. Rationale Once we'll find the extent and severity of esophageal injury associated with corrosive intake within 24 hours, we'll be able to manage the case timely and to limit further complications and disabilities. Materials and Methods This descriptive cross-sectional study was conducted on 150 patients who presented with corrosive ingestion and underwent urgent endoscopic evaluation. Data were collected using self-designed pro forma. Endoscopic findings were classified according to the Zargar classification. A descriptive analysis of study variables was performed using SPSS v.21.0 (IBM Corp., Armonk, NY, USA). The chi-square test was used, and a p-value of less than 0.05 was considered statistically significant. Results Out of 150 patients under study, 103 (68.7%) were females and 47 (31.3%) were males. The most prevalent age group presenting with corrosive intake was found to be between 21 and 34 years of age (43.3%) in both genders. The most common part of the esophagus prone to corrosive insult is the upper esophagus (99.3%), whereas, regarding severity, the lower esophagus has more severe injuries (predominant being stage 2B, i.e., 32%). There are no statistically significant differences in esophageal injuries in different age groups (upper esophageal injury: 0.319; lower esophageal injury: 0.696) and genders (upper esophageal injury: 0.769; lower esophageal injury: 0.752). Conclusions Most of the patients under study belong to the female gender and teen and younger age group. The predominant upper esophageal injury as a result of corrosive intake is stage 0 injury, and the least common is found to be stage 1 injury. The predominant lower esophageal injury as a result of corrosive intake is stage 2B injury, whereas the least common is found to be stage 4 injury.

Implications of Social Factors and Management Outcomes Among Patients with Corrosive Ingestion

“…The female tendency for corrosive ingestion is well established and remains undisputed nationally and internationally 16,17 . A 2012 study in Macedonia reported ratio of females and males is 2.5:1.…”

Acute Management in Corrosive Ingestion

“…Post-corrosive esophageal stricture should highly consider inpatient with Zargar grade 2b and 3a [4,5,8,9,16,55]. Although various treatment strategies have been developed, none of them can provide outstanding results.…”

Terapia endoscópica a vácuo versus stents metálicos autoexpansíveis para o tratamento de defeitos transmurais do trato digestivo superior: revisão sistemática e metanálise

“…As perfurações são oriundas de um grande grupo de etiologias, desde procedimentos terapêuticos por via endoscópica até ingestão de corpo estranho, substância corrosiva ou mesmo em decorrência de patologias específicas, tais como a síndrome de Boerhaave [4][5][6] . As fístulas, por sua vez, decorrem de uma gama de fatores, desde a evolução de uma deiscência, até complicações de doenças específicas, tais como a doença de Crohn 7 .…”