Caustic ingestion in children: is endoscopy always indicated? The results of an Italian multicenter observational study

Betalli, Pietro; Falchetti, Diego; Giuliani, Stefano; Pane, Alessandro; Dall’Oglio, Luigi; Angelis, G.L. De; Caldore, Mariano; Romano, Claudio; Gamba, Piergiorgio; Baldo, Vincenzo

doi:10.1016/j.gie.2008.02.016

Cited by 124 publications

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“…The initial signs and symptoms of patients are the main factors which determine the treatment and follow-up goals in emergency clinics before endoscopy. 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].…”

Section: Discussionmentioning

confidence: 99%

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

Uyar¹,

Kök²

2017

J Clinic Toxicol

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Context: The endoscopic degree of injuries is the main finding for further management of caustic ingestions. However, if endoscopy cannot be performed quickly, clinicians decide on treatment and follow-up goals according to the signs and symptoms of the patient. The aim of this study was to determine the association of white blood cells (WBC), C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) with the degree of caustic injury and to evaluate whether NLR is able to predict the severity of injuries. Materials and methods:A retrospective evaluation was made of a total of 190 patients with a mean age of 38.6 years. WBC, neutrophil, lymphocyte and CRP values and endoscopic findings of all patients at hospital admission were retrieved from hospital files. The association between WBC, NLR, CRP and endoscopic findings was evaluated.Results: Endoscopy was normal in 28 of 119 patients (23.5%) and most patients (42 of 119 (35.3%) had only gastric involvement. NLR was significantly higher in patients with injuries than normal patients (p=0.010), whereas WBC and CRP not. NLR was also significantly higher in patients with both esophagus and gastric injuries compared to patients with no organ involvement (p<0.001). NLR, WBC and CRP were weakly correlated to the grade of involvement. In the ROC analysis, the AUC value was 0.914 (95% CI (0.85-0.96, p<0.001)) and the cut-off value for NLR was 8.71 with sensitivity of 90% and specificity of 91.7% for discriminating injuries as grade 0-1-2 from 3-4. Conclusions:Higher NLR values showed widespread and severe involvement of caustic ingestion. NLR also seems to be a more reliable method to make a distinction between severe and mild injuries. It is an easily derived and inexpensive marker of inflammation and might guide the management of patients before endoscopic evaluation in emergency departments.

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Section: Discussionmentioning

confidence: 99%

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

Uyar¹,

Kök²

2017

J Clinic Toxicol

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“…However, in a larger study, Gaudreault et al (16) stated that signs and/or symptoms do not adequately predict the presence or severity of an esophageal lesion. Betalli et al (17) proposed that the incidence of patients with thirddegree lesions without any early symptoms and/or signs is very low, and endoscopy could be avoided. However, in our study, a patient who developed esophageal strictures only had Grade IIB corrosive esophagitis.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal system lesions in children due to the ingestion of alkali andacid corrosive substances

Demirören¹,

Kocamaz²,

Doğan³

2015

Turk J Med Sci

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The ingestion of corrosive substances among children mostly occurs accidentally. Most of these corrosive agents are household cleaners, and the esophagus is the most damaged site of the gastrointestinal system. Perforation and death are potential serious complications in the acute period, while stricture and cancer can occur over chronic periods of time. Endoscopic inspection in the early hours after ingestion is very important for the evaluation of the lesions to allow the planning of the appropriate treatment and follow-up care of these patients (1-3).In this study, we investigated children who were admitted to our clinic due to corrosive substance ingestion or suspected ingestion and who subsequently underwent an upper gastrointestinal endoscopy. The aim of this study was to examine esophageal and gastric lesions in children due to the ingestion of alkaline and acidic corrosive substances and to emphasize all relevant complications. Materials and methodsOne hundred and three children who were admitted to our pediatric gastroenterology unit during a 3-year period complaining of corrosive substance ingestion and who subsequently received upper gastrointestinal endoscopies were enrolled in this study. Clinical and endoscopic findings, treatment regimes, and long-term complications were retrospectively evaluated.The endoscopic procedure was first performed with a 5-mm diameter flexible endoscopy device (Olympus Evis Lucera CLV-260SL) 12-24 h after the ingestion of the corrosive substance in the patients admitted to our clinic. Before the procedure, 0.1-0.4 mg/kg intravenous midazolam was administered to sedate the patients.Background/aim: To examine esophageal and gastric lesions in children due to the ingestion of alkali and acid corrosive substances and to emphasize all related complications. Materials and methods:The reports of 103 children who ingested or were suspected to have ingested corrosive substances and who then underwent upper gastrointestinal endoscopic inspections were evaluated retrospectively.Results: Of the patients, the mean age was 41 ± 3.6 months, and 57.3% were male. Vomiting was the most common symptom (44.7%). Eighteen different commercial products were defined as corrosive substances: 59.2% of them were alkali, 39.8% were acids, and 1% had a neutral pH. These corrosive agents most frequently contained sodium hydroxide, followed by hydrochloric acid, sodium hypochlorite, and sulfuric acid. Endoscopic inspections were abnormal in 68% of the cases. Esophageal lesions were observed in 56.3% of the patients, while gastric lesions were observed in 35%. During the follow-up period, esophageal strictures developed in 4.9% of patients, while gastric outlet obstructions developed in 1%. Conclusion:Of the patients, the mean age was 41 ± 3.6 months, and 57.3% were male. Vomiting was the most common symptom (44.7%). Eighteen different commercial products were defined as corrosive substances: 59.2% of them were alkali, 39.8% were acids, and 1% had a neutral pH. These corrosive agents most frequently con...

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“…The most frequently ingested substances, such as caustic soda, have a powerful solvent action that results in very serious injuries, as confirmed by 73% of children needing gastrostomy feeding, in sharp contrast with the 11% of severe injuries reported in a multicentric study from a high-income country. 15 Many injuries do recur, with one-fifth of patients still requiring a continuous dilatation programme. Unfortunately, longterm dilatation programmes are very challenging in low-income countries.…”

Section: Discussionmentioning

confidence: 99%

Oesophageal corrosive injuries in children: a forgotten social and health challenge in developing countries

Contini¹,

Swarray‐Deen²,

Scarpignato³

2009

Bull World Health Org

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Problem An unsafe environment is a risk factor for child injury and violence. Among those injuries that are caused by an unsafe environment, the accidental ingestion of corrosive substances is significant, especially in developing countries where it is generally underreported. Approach To address this challenging, unmet medical need, we started a humanitarian programme in Sierra Leone. By reviewing the current literature from developing countries and our own experience in the field, we developed a flowchart for management of this clinical condition. Local setting This injury is underreported in developing countries. Data available are heavily skewed towards well-resourced centres and do not reflect the entire reality of the condition. Late oesophageal strictures are usually severe. Parent's lack of knowledge, crowded living conditions and availability of chemicals in and around houses account for most ingestions. The widespread lack of any preventive measures represents the strongest risk factor. Relevant changes Timely admission was observed in 19.5% of 148 patients studied. A gastrostomy was performed on 62.1% of patients, 42.8% had recurrent strictures and 19% are still on a continuous dilatation programme. Perforation and death rate were respectively 5.6% and 4%. Lessons learned The majority of oesophageal caustic strictures in children are observed late, when dilatation procedures are likely to be more difficult and carry a significantly higher recurrence rate. Gastrostomy is necessary to maintain adequate nutritional status but mothers need training in feeding techniques. Both improvement in nutritional status and sustained oesophageal patency should be the reference points to a successful dilatation.Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español. ‫املقالة.‬ ‫لهذه‬ ‫الكامل‬ ‫النص‬ ‫نهاية‬ ‫يف‬ ‫الخالصة‬ ‫لهذه‬ ‫العربية‬ ‫الرتجمة‬

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Caustic ingestion in children: is endoscopy always indicated? The results of an Italian multicenter observational study

Cited by 124 publications

References 20 publications

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

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

Gastrointestinal system lesions in children due to the ingestion of alkali andacid corrosive substances

Oesophageal corrosive injuries in children: a forgotten social and health challenge in developing countries

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