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).