Caustic stenosis of the esophagus and malignant neoplasia: A dilemma

Abstract

Caustic ingestion remains a complex public health issue worldwide, in adults and children. Caustic agent (acids and alkalis) is a product that causes tissue damage, and its ingestion will damage the mouth, pharynx, hypopharynx, esophagus, stomach, duodenum, and may reach the jejunum. Concomitant gastric and intestinal injuries can occur in 20 to 60% (1-3) Acid products, most of the times, cause coagulative necrosis of the mucosa, while alkalis cause a liquefaction/saponification effect on the mucosa, reaching the entire wall of the organ. The most accessible acids are hydrochloric, sulfuric and oxalic acid, widely used in civil construction and factories. Products that contain alkali are those used in household cleaning, containing sodium hydroxide, also known as caustic soda. Therefore, caustic stenosis of the esophagus depends on the product ingested, the amount that was ingested and its concentration (1, 4-6).Ingestion of these products damages the esophagus, in different extensions, and the final consequence is progression to stenosis and fibrosis of the organ. The most common symptom is dysphagia, and the intensity of dysphagia depends on the degree of stenosis. Odynophagia is also present. The nutritional status injury is evident, due to significant weight loss (1,2,4,7).Developing countries have a higher incidence of this kind of accident. In children under 10 years of age, ingestion is most often accidental, however, in adolescents and adults, the etiology of ingestion is due to attempted suicide. In the United States, despite the decline in caustic intake in children (5,000 to 15,000 per year), the incidence is 15.8 cases per 100,000 peoples (8).

Severe Intentional Corrosive (Nitric Acid) Acute Poisoning: A Case Report and Literature Review

“…Since various gradings of the injuries can be highlighted throughout the length of the upper digestive tract [ 49 ], great benefits can result from an early complete endoscopic assessment mainly concerning the interventional and/or surgical therapeutical approach. Co-existing gastric and intestinal injuries can be found in about 20 to 62.5% of cases [ 51 , 52 ].…”

“…During the long-term follow-up, endoscopic surveillance is recommended to allow early detection of pre-cancerous dysplastic lesions. No consensus has been established regarding the optimum interval to perform endoscopy, but every 2 to 3 years seems to be the most accepted strategy among specialists [ 51 ]. Nonetheless, given the features of corrosive-induced esophageal cancer (preexisting dysphagia due to the presence of chronic strictures and various morphologies of the luminal narrowing that may limit the accuracy of endoscopic mapping), additional paraclinical investigations, such as barium esophagography and/or contrast computed tomography imaging tests, may be needed to successfully detect malignant lesions [ 77 ].…”

“…In the acute phase, the severity of corrosive poisoning may vary, from minor injuries to life-threatening conditions, such as perforation, bleeding, necrosis of the esophagus and stomach, sepsis, and shock [ 45 , 54 , 78 , 79 ]. The most common complications involve esophageal and gastric damage that may lead to an extensive scarring process, various degrees of luminal stricture, malnutrition, and a higher (more than a 1000-fold) risk of malignant transformation of the altered epithelium [ 51 , 80 ].…”

“…The estimated amount of time needed for esophageal cancer to develop is about 15-to-40 years after corrosive substance exposure and the initiation of the carcinogenesis process [ 51 , 81 ]. With a prevalence of up to 16% of cases, the predominant histological type of esophageal cancer is the squamous cell carcinoma [ 51 , 77 , 80 , 81 ].…”

“…The estimated amount of time needed for esophageal cancer to develop is about 15-to-40 years after corrosive substance exposure and the initiation of the carcinogenesis process [ 51 , 81 ]. With a prevalence of up to 16% of cases, the predominant histological type of esophageal cancer is the squamous cell carcinoma [ 51 , 77 , 80 , 81 ]. The expansion of the tumor from a cicatricial tissue seems to have a favorable impact on the outcome of patients and the 5-year survival rate, since the intra- and peri-tumoral presence of fibrotic tissue might limit the local spread and lymphatic dissemination [ 51 , 80 , 82 ].…”