Clinical and Endoscopy Findings in Children With Accidental Exposure to Concentrated Detergent Pods

Abstract

Background: Caustic ingestion with concentrated detergent pods (CDPs) is a common problem encountered in pediatric population. There is insufficient literature about endoscopic findings in CDP ingestion and hence no current consensus or guidelines regarding the need for endoscopic evaluation. Objectives: To review cases of children with exposure to CDPs from 2010 to 2016 at a tertiary care children's hospital and to identifying the possibility of a correlation between clinical presentation and the endoscopic findings. Methods: A retrospective review identified pediatric patients with accidental caustic exposure to CDPs. Data on demographics, type of exposure, clinical symptoms, physical examination, details of the hospital course were collected. Esophagogastroduodenoscopy (EGD) findings and direct laryngoscopy-bronchoscopy findings were also collected. Descriptive statistics were computed for all demographic and clinical variables. The association between EGD findings and clinical presentation were tested using Fisher exact test. Results: A total of 23 (28%) cases of CDP ingestion were identified out of 83 total cases of caustic ingestion between January 2010 and June 2016. Median age was 15 months. gastrointestinal symptoms were present in 21 (91%) patients. Examination findings were present in 8 of 23 (35%) patients. EGD (done by gastroenterologists) evaluation was done in 21 (91%) patients and positive findings were seen in 5 of 21 (24%). The proportion of patients with positive examination findings was significantly higher in patients with positive EGD findings (80% vs 20%, respectively; P = 0.0307). Direct laryngoscopy-bronchoscopy (done by otolaryngologists) evaluation was done in 6 (26%) patients and positive findings were seen in 4 of 6 (67%). Conclusions: Our results suggest that oropharyngeal examination findings increase the likelihood of endoscopy findings; hence, we recommend endoscopic evaluation of patients who have examination findings secondary to exposure to CDPs. In other patients, it will be reasonable to evaluate the need for endoscopy on a case-by-case basis.

Dark side of laundry pods: Analysis of exposure to laundry detergent capsules in children

“…Our analysis, similar to the study by Settimi et al, 11 showed that both boys and girls were exposed to capsules with the same frequency. On the other hand, girls dominated in the study by Yin et al, 14 while boys predominated in the study by Singh et al 10 In our study group, only 44.74% of patients could accurately determine the capsule brand with which the child had contact. In the Williams et al's study, the capsule brand was determined in 93.4% of patients.…”

“…In the study of Singh et al ., it was found that endoscopic examination should be performed in patients who show abnormalities on physical examination for LDC exposure. The authors of this study stated that the presence of abnormalities in the physical examination of the oral cavity correlated with 80% probability of the presence of pathological changes in the gastrointestinal tract revealed during gastroscopy 10 . On the other hand, Smith et al .…”

“…On the other hand, Singh et al . observed a decrease in the incidence of LDC exposure since 2014 10 . Settimi et al .…”

“…On the other hand, Singh et al observed a decrease in the incidence of LDC exposure since 2014. 10 Settimi et al noticed a significant decline in exposure to LDC (from 1.03 to 0.36 cases/day and from 1.88 to 0.86 cases/ million units sold), which occurred 4 months after the introduction of opaque outer packaging in the major company producer of LDC in Italy. 11 Our results are consistent with a research by Williams et al who pointed out that 95.6% children were also below 5 years of age.…”

“…The authors of this study stated that the presence of abnormalities in the physical examination of the oral cavity correlated with 80% probability of the presence of pathological changes in the gastrointestinal tract revealed during gastroscopy. 10 On the other hand, Smith et al emphasised that the lack of changes in the physical examination does not exclude a chemical burn of the oesophagus after ingestion of the LDC contents, and the correlation between abnormalities in oropharyngeal examination, and findings in gastroscopy. 19 In our study, no relationship was found between the decision to perform gastroscopy, and the child's age and presentation of symptoms.…”