Caustic injury of the upper gastrointestinal tract: A comprehensive review

Abstract

Prevention has a paramount role in reducing the incidence of corrosive ingestion especially in children, yet this goal is far from being reached in developing countries, where such injuries are largely unreported and their true prevalence simply cannot be extrapolated from random articles or personal experience. The specific pathophysiologic mechanisms are becoming better understood and may have a role in the future management and prevention of long-term consequences, such as esophageal strictures. Whereas the mainstay of diagnosis is considered upper gastrointestinal endoscopy, computed tomography and ultrasound are gaining a more significant role, especially in addressing the need for emergency surgery, whose morbidity and mortality remains high even in the best hands. The need to perform emergency surgery has a persistent long-term negative impact both on survival and functional outcome. Medical or endoscopic prevention of stricture is debatable, yet esophageal stents, absorbable or not, show promising data. Dilatation is the first therapeutic option for strictures and bougies should be considered especially for long, multiple and tortuous narrowing. It is crucial to avoid malnutrition, especially in developing countries where management strategies are influenced by malnutrition and poor clinical conditions. Late reconstructive surgery, mainly using colon transposition, offers the best results in referral centers, either in children or adults, but such a difficult surgical procedure is often unavailable in developing countries. Possible late development of esophageal cancer, though probably overemphasized, entails careful and long-term endoscopic screening.

Neutrophil to Lymphocyte Ratio as a Predictor of Endoscopic Damage in Caustic Injuries

“…Patients with grade 1 or 2A injury are permitted oral intake earlier and are generally discharged within days with antacid therapy. Patients with grade 2 or 3 injury however, are more severe cases and may need closer observation and may stay longer in hospital [2]. In the current study, the endoscopic findings of 28 patients (23.5%) were normal and most of the patients (42/119) had gastric involvement.…”

“…Betalli et al reported that the presence of symptoms was the strongest predictor of severe esophageal lesions in a multi-centre observational study of a pediatric population [18]. Endoscopy is usually recommended in the first 12-48 hours after caustic ingestion [2] and is reliable for up to 96 hours after the injury [17]. The degree of injury determined on endoscopy is the major finding for patient management and prediction of complications.…”

“…Late sequelae of caustic injuries include strictures in the esophagus and stomach, gastric outlet obstruction, mucosal metaplasia and carcinoma [4]. These complications of caustic injuries are detected with upper gastrointestinal endoscopy and endoscopic findings are the major predictor of the formation of late complications [2,5]. However, endoscopy is not always feasible especially in developing countries where these events are common.…”

“…Altough mainly seen in children, these injuries can also be seen in adults, both intentionally and accidentally [1]. Caustic ingestion may cause esophageal and gastric superficial edema, erythema, erosions, ulcerations, necrosis and ultimately perforation in the early period [2]. Patients with perforation have to be diagnosed without any loss of time, as immediate surgical intervention may be required [3].…”

The Role of Second-look Endoscopy in Severe Esophageal Caustic Injury

“…Some researches mentioned it's safe to repeat endoscopy up to 3 weeks after caustic injury in expert hands [13,14]. Although upper gastrointestinal series plays the role in clinical evaluation, it's not as precise as endoscopic examination.…”