Corrosive oesophageal strictures following acid ingestion: Clinical profile and results of endoscopic dilatation

Abstract

There are several reports on oesophageal strictures caused by alkali ingestion, but information on oesophageal strictures due to acid ingestion is scarce. Endoscopic dilatation, which has been found to be quite safe and effective in the treatment of benign oesophageal strictures of other aetiology, has also not been evaluated adequately in the treatment of these strictures. Over a period of 2 years, of 47 patients treated at this centre of benign oesophageal strictures, 17 (36.2%) patients had strictures following ingestion of corrosive agents. Thirteen patients had ingested acids and only four gave a history of alkali ingestion. The age range of these 13 patients was 14-50 years (mean = 25.5 years, s.d. = 2.6). The amount of acid ingested varied from 10 to 100 ml (median = 50 ml). The interval between acid ingestion and presentation to hospital ranged from 1 to 60 months (median = 2 months). Ten patients had multiple strictures, and the most common site of involvement was the upper third followed by the lower third of the oesophagus. Only five of these 13 patients had evidence of gastric involvement in the form of antral stricture (four) and hour glass deformity (one). Strictures were dilated using Eder-Puestow metal olives passed over a guide wire. The total number of sittings required to achieve adequate dilatation in this group ranged from 1 to 30 (median = 14). Most patients were managed successfully with dilatation (good response 63.6%, satisfactory response 18.2%). On follow-up, recurrence of dysphagia was seen in a high number of patients (66%), but this could be managed easily with repeat dilatation.(ABSTRACT TRUNCATED AT 250 WORDS)

Management of Acid- and Alkali-Induced Esophageal Strictures in 79 Adults by Endoscopic Dilation: 8-Years’ Experience in New Delhi

“…While the studies from Western countries show that alkali has been the most common corrosive ingested by most patients with esophageal strictures [16,18,19], in India acids have been implicated more often [3,4,6,8] as seen in our study in which acid ingestion led to 57% of the strictures. This is probably because of the easy availability of strong mineral acids such as sulfuric acid and hydrochloric acid which are commonly used as toilet-cleaning agents in India.…”

“…This is probably because of the easy availability of strong mineral acids such as sulfuric acid and hydrochloric acid which are commonly used as toilet-cleaning agents in India. Contrary to the usual belief that acids ''lick the esophagus and bite the stomach'' while alkalis ''bite the esophagus and lick the stomach,'' esophageal strictures have been reported after acid ingestion [4,13]. Some factors such as an alkaline environment in the esophageal lumen and quick transit through the esophagus protect the esophagus from injury by acids.…”

“…Contrary to the situation in Western countries where alkali-induced strictures are more common, acid has been found to be a more frequent cause of strictures in India. Acid ingestion has been found to be a cause in less than 5% of the stricture cases in United States, while in India it has been found to be involved in about 70%-80% [4,[13][14][15][16]. Most of the ingestions in India are accidental rather than suicidal [15].…”

“…Most of the ingestions in India are accidental rather than suicidal [15]. The common acids ingested in India are sulfuric acid, hydrochloric acid, nitric acid, and carbolic acid [4,15,16], while in the U.S. alkalis such as sodium hydroxide, sodium hypochlorite, and sodium tripolyphosphates are easily available and are the common offenders along with acids such as oxalic acid and hydrofluoric acid [16]. In this study we aimed to determine the safety and efficacy of endoscopic dilation using Savary-Gilliard (SG) and balloon dilators in the management of corrosive esophageal strictures and compare results with regard to acid-vs. alkali-induced strictures.…”

“…Management of corrosiveinduced strictures of the esophagus by endoscopic dilation or surgery has been universally tried and accepted. In endoscopic dilation various types of dilators such as balloon dilators [1], Eder Puestow metal olives [2][3][4][5], Maloney dilators (mercury bougies) [2], Gum elastic bougie [6], and Savary-Gilliard dilators [3] have been used with variable results. Though there is a consensus among authors that endoscopic dilation of corrosive strictures is the therapy of choice, which dilator is the safest and most effective is still controversial.…”