Endoscopic findings and outcome in caustic ingestion of acidic and alkaline agents in adults

Abstract

Caustic ingestion in adults is a rare but potentially life-threatening problem. It remains controversial whether endoscopic findings and mortality differ between acid and alkali ingestion. We compared ingestion of these agents and evaluated prediction parameters for survival and complications.Adult patients who presented with caustic ingestion were analyzed from 2005 to 2016. Mucosal injury was graded endoscopically by Zargar's score. Age, gender, intent of ingestion, caustic agents, comorbidities, management, complications, and mortality were examined.Thirty-one patients met inclusion criteria and were divided into acid (n = 10) and alkali group (n = 21). Ingestion of alkali resulted in higher grades (≥III) of esophageal (56% vs 24%, P = .01) and stomach injuries (43% vs 13%, P = .05) and was mostly done with suicidal intent (76% vs 30%, P = .003). Patients in the alkali group received more often surgical interventions, mechanical ventilation and tracheotomy. Overall complications including Zargar's-score ≥ grade III, mediastinitis, and aspiration pneumonia were higher in alkali group but all showed no statistical significance (P = .73). Mortality (acid: 1 (10%), alkali: 4 (19%), P = .52), age, gender, comorbidities, and intensive care management did not differ significantly between the groups. Chronic renal failure and mediastinitis were promising prediction parameters for mortality but did not reach statistical significance. No independent risk factors for the development of esophageal stenosis were identified.Alkaline agents caused a higher mucosal injury severity and were more often used in suicidal intent. Mediastinitis and chronic renal failure might be potential prediction parameters for survival but need to be evaluated in larger studies.

Acute management of caustic injury patient in low-resource settings

“…In patients with stage IIB and III with damage from corrosive substance injury, a nasogastric tube for feeding should be placed within the first 24 h, and enteral fluids can be started within the first 48 h, especially if the patient can swallow his or her saliva [12] , [15] . Emergency surgery is indicated primarily on the clinical condition of the patient as compared to the radiological results.…”

Esophageal Stricture Caused by the Ingestion of Undissolved Picosulfate Powder

“…Tissue injury caused by corrosive alkaline and acidic substances vary depending on the type, quantity, concentration, and contact time [ 9 ]. Acidic agent-driven corrosive esophagitis is rare; however, it can lead to a similar [ 10 ] or sometimes worse outcome [ 9 ] than that induced by alkaline agents.…”

Esophagogastric Complications After Caustic Ingestion: A Case Report

“…After the correct identification of the features mentioned above, it is important to note that specific corrosive agents may cause other systemic effects such as hyponatremia, hypokalemia, and acidosis, especially with strong acids and alkalis, nevertheless, this is not always present. Moreover, it has been proven that the development of severe mucosal injury, renal failure, and mediastinitis have a worse prognosis [8]. For all the reasons explained above, the correct identification and prompt classification of the lesions using the endoscopic Zargar scale has great importance in these cases (Table 1).…”

“…Hollenbach et al described that the patients over 65 years old and the ones who ingested alkali were more likely to develop severe lesions and had higher mortality. However, these data were obtained with a short sample, and studies with a greater cohort are suggested [8].…”