Clinical characteristics and predisposing factors for complication of caustic injury of the upper digestive tract

Yeom, Hye Jung; Shim, Ki Nam; Kim, Seong Eun; Lee, Chang Bai; Lee, Jong Soo; Cho, Yoo Kyung; Kim, Tae Hun; Jung, Sung Ae; Kwon, Yoo; Moon, Il Hwan

Abstract

BACKGROUND: Accidental or suicidal ingestion of caustic agents is not uncommon. The caustic injury of upper digestive tract can lead to severe stenotic sequelae. We attempt to investigate clinical characteristics, endoscopic findings and predisposing factors of development of complications of caustic injury.
METHODS
The medical records of 77 patients admitted to our department for caustic ingestion from March, 1993 to June, 2004 were reviewed. All patients underwent initial endoscopic examinations and caustic lesions were graded according to Zargar's classification (Grade 0~III).
RESULTS
Strictures of the esophagus and the stomach occurred in 12 patients (15.6%) and 3 patients (3.9%), respectively. The development of esophageal or gastric stricture was more frequent when the grade of caustic injury of the esophagus or the stomach was more severe. Hemorrhage from exposed vessels of the injured esophagus and stomach was seen in one patient and so was jejunal hemorrhage. Two patients (2.6%) died of multiple-organ failure. All cases of hemorrhage and death resulted from grade III lesions of the esophagus, stomach and duodenum. The type or amount of the caustic agent, duration between ingestion and endoscopic examination, and initial treatment with steroid and/or antibiotics did not correlate with the development of stricture.
CONCLUSIONS
Caustic injury of the esophagus and the stomach was significantly associated with esophageal stricture. Early endoscopic examination was very useful for predicting the development of complications and prognosis after caustic injury.