LXVI Management of Esophageal Lesions Caused by Chemical Burns

Holinger, Paul H.

doi:10.1177/000348946807700501

Cited by 43 publications

(14 citation statements)

References 7 publications

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“…4 The role of endoscopic examination of the upper gastrointestinal tract following caustic substance ingestion has changed considerably. In the past, endoscopy was discouraged because of the high rate of perforation with the use of rigid endoscopes, 15 but the use of flexible endoscopes has allowed safe evaluation of the upper gastrointestinal tract following caustic substance ingestion. 16,17 When injury from a caustic substance occurs, early endoscopic examination defines the extent of the injury and facilitates logical management.…”

Section: Discussionmentioning

confidence: 99%

Ingestion of Caustic Substances by Adults

Satar

Topal

Kozacı

2004

American Journal of Therapeutics

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Caustic products are responsible for the most serious cases of poisoning, which are always emergency cases. In this paper, we review demographic features and endoscopic results of the patients admitted to a university emergency department with a history of caustic substance ingestion between January 2000 and June 2003. Thirty-seven patients were included in this study. Twenty-one of the patients were female and 16 were male. The mean age of the patients was 30.9 +/- 14.7 years. The agents included sodium hypochlorite in 24 patients and hydrochloric acid in 13 patients. All the patients ingested these agents orally. The mean interval time of admission to emergency department after ingestion of caustic agent was 5.4 +/- 5.6 hours. Endoscopy was attempted in 37 patients. Endoscopic results were as follows: grade 0 in 8 (21.6%) patients, grade 1 in 17 (45.9%) patients, grade 2a in 5 (13.5%) patients, and grade 2b in 7 (18.9%) patients. We believe that early signs and symptoms after caustic substance ingestion are not consistent with the extent of damage, and endoscopy is the only reliable method to assess injury. It is important that efforts should be made to educate the public about the dangers of caustic substances so that their threat may be diminished.

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Section: Discussionmentioning

confidence: 99%

Ingestion of Caustic Substances by Adults

Satar

Topal

Kozacı

2004

American Journal of Therapeutics

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“…None of the esophageal burns produced in this study produced an ulceration that penetrated the muscularis mucosa, thus all would be first degree burns by Holinger's classification. 1 Esophageal injuries in this category need be treated only with the proper emergency measures and subsequent symptomatic follow-up care.…”

Section: Resultsmentioning

confidence: 99%

Effect of Chlorine Bleach on the Esophagus

Hook¹,

Lowry²

1974

Ann Otol Rhinol Laryngol

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The stimulus for this review and study was the report of experimentally produced esophageal burns in animals secondary to Clorox® ingestion which was reported by previous investigators in Chicago. Twenty-six children have been admitted to Children's Memorial Hospital since 1969 with “bleach ingestion” as the diagnosis. All but six underwent esophagoscopy in compliance with a “Pediatrics-Otorhinolaryngology Study Protocol” in an attempt to diagnose esophageal burns. Chemical burn of the esophagus was found in only one case; however, the exact content of ingested material was not definitely identified. In the one case of chemical burn, treatment was performed per protocol, and the patient is free of symptoms of stricture eighteen months postingestion. None of the other twenty-five patients have returned for treatment of ingestion sequelae. A laboratory study was conducted which utilized cats to simulate Clorox® ingestion by children. The cats were sacrificed at varying periods of time following ingestion with gross and microscopic exam of each esophagus being performed. Results showed the potential of chlorine bleach to cause chemical burns and superficial ulceration, but no stricture or residual sequelae when ingested in a manner simulating physiologic swallowing. Appropriate conclusions were made in respect to treatment of future patients with the diagnosis of “bleach ingestion.”

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“…The Hollinger classification is a system for grading endoscopic findings of caustic esophageal injuries similar to that used for heat burns of the skin. It has been proven a useful tool for choosing the optimal treatment 17,21,24 . The patients with grade I esophageal burns were treated with H2 blockers and antibiotics, whereas those with grade II or III burns were given corticosteroids in addition to H2 blockers and antibiotics.…”

Section: Discussionmentioning

confidence: 99%

“…It has been proven a useful tool for choosing the optimal treatment. 17,21,24 The patients with grade I esophageal burns were treated with H2 blockers and antibiotics, whereas those with grade II or III burns were given corticosteroids in addition to H2 blockers and antibiotics. Co-administration of corticosteroids, H2 blockers and antibiotics is highly recommended, especially in cases of esophageal burns caused by alkali.…”

Section: Discussionmentioning

confidence: 99%

Conservative management of caustic substance ingestion in a pediatric department setting, short-term and long-term outcome

Karagiozoglou–Lampoudi

Agakidis

Chryssostomidou

et al. 2011

Diseases of the Esophagus

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Patients with caustic substance ingestion are usually referred to surgery departments where endoscopic evaluation is the first step towards appropriate treatment. The aim of this study was to evaluate the safety and efficacy of conservative management of caustic substance ingestion in a pediatric department setting following a standard protocol including endoscopy in selected cases and conservative treatment based on clinical and endoscopy criteria. In this single center observational study, all children admitted for caustic substance ingestion to a pediatric department over an 8-year-period were managed according to a standard protocol that included endoscopy within 24 hours, if the endoscopy criteria were met, and conservative treatment as judged appropriate according to endoscopic classification. Patients were followed up for 8-10 years. Of the 24 patients (age 4/12 to 6 years) admitted, 14 met the endoscopy criteria. Grade II and III esophageal burns were found in 10/14 patients, and they were treated with H2-blockers, antibiotics, corticosteroids, and nutritional support (parenteral in 8/10). Patients with grade II or III esophageal burns necessitated prolonged hospitalization (x ± standard deviation, 23 ± 3 days; range, 21-30 days). Complications included esophageal strictures (n = 1), treated successfully with dilatations, and bleeding (n = 1) treated conservatively. During the 8- to 10-year follow-up all patients were recorded being well. Based on the study findings it is concluded that conservative management of children with caustic substance ingestion using a standard protocol, including endoscopy as indicated, is feasible within the pediatric department, and conservative treatment on demand is safe and effective in preventing short-term and long-term complications.

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LXVI Management of Esophageal Lesions Caused by Chemical Burns

Cited by 43 publications

References 7 publications

Ingestion of Caustic Substances by Adults

Ingestion of Caustic Substances by Adults

Effect of Chlorine Bleach on the Esophagus

Conservative management of caustic substance ingestion in a pediatric department setting, short-term and long-term outcome

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