Nutritional Therapy in the Treatment of Acute Corrosive Intoxication in Adults

Abstract

Introduction: Acute intoxications with corrosive substances can cause severe chemical injuries of the upper gastrointestinal tract, most often located in the mouth, pharynx, esophagus, stomach and duodenum. If a patient survives the acute phase of intoxication, regenerative response may result in esophageal and/or gastric stenosis, and increased risk of esophageal and gastric cancer. Such intoxication may be fatal due to perforation or tracheal necrosis. Enteral nutrition is a nutritional method when nutritional substances are administered through specially designed tubing placed through the nose or percutaneously, directly into the GIT. Aim: The aim of this study is to describe the methods of artificial nutrition in patients with acute corrosive intoxications and the importance of nutritional support in the treatment of these intoxications. Discussion: Nutrition in the treatment of acute corrosive intoxications is one of the most important therapeutic processes that largely contribute to faster recovery of the post-corrosive injuries of upper GIT, stabilization of biologic, immunologic and metabolic parameters, and reduction of length of stay in hospital Aim of the treatment of acute corrosive intoxications is to prevent perforation and progressive fibrosis, and esophageal and gastric stenosis. There are different and often conflicting positions, on the conservative treatment of acute corrosive intoxications in adults. Such treatment mainly consists of anti-secretory treatment, antibiotics and intensive hyper-alimentation, aiming to prevent late post-corrosive intoxications. Conclusion: It is considered that nutritional support plays a major role in maintenance of metabolic processes and prevention of severe metabolic complications that could additionally aggravate the condition and impair the treatment.

Histopathological changes in the oesophageal mucosa in Egyptian children with corrosive strictures: A single-centre vast experience

“…The Lugol's iodine solution used to detect the dysplastic areas of mucosa was sprayed onto the oesophageal surface from the gastro-oesophageal junction to the upper oesophageal sphincter using the dye-spraying catheter through the biopsy channel. This protocol is in agreement with the methods of Chibishew et al[12], who reported that the routine endoscopic biopsy of normal-appearing mucosa or biopsies guided by tissue staining with Lugol’s solution may increase the detection of dysplasia or mild oesophageal cancer. Narrow band imaging- magnifying endoscopy helps in visualization of oesophageal mucosa and surveillance of oesophageal precancerous lesions[21].…”

“…This result may be attributed to the fact that in liquid form, bases are tasteless and denser than water[13], while strong acids are bitter and are commonly expectorated[4]. Potash is potassium hydroxide, it used in oven cleaners, liquid agents, liquid drain cleaners, disk batteries household cleaners, dishwater detergents[12,13]. The median and range of patients’ weight and height by Z-score were -1.20 (-10.81-1.91) and -2.11 (-5.82-0.61), respectively.…”

“…The negative- image "unstained lesions" (USLs) after spraying iodine can be endoscopically targeted for biopsy and/or focal endoscopic therapy[10]. The routine endoscopic biopsy of normal- appearing mucosa or biopsies guided by tissue staining with Lugol’s solution may increase the detection of dysplasia or early oesophageal cancer[12]. This study was designed to screen post-corrosive children for the risk of development of oesophageal mucosal dysplasia to assess the safety of prolonged endoscopic dilatation of post-corrosive oesophageal stricture.…”

Guía de práctica clínica Ibero-Latinoamericana sobre la esofagitis cáustica en Pediatría: Aspectos terapéuticos (2ª. Parte)

“…La nutrición es uno de los aspectos terapéuticos más importante ya que contribuye en gran medida a la recuperación más rápida de las lesiones del tracto digestivo, la estabilización de los parámetros biológicos, inmunológicos y metabólicos, además de lograr disminuir la estancia en hospitalización. El soporte nutricional temprano es de gran importancia porque reduce las infecciones y el riesgo de desarrollar neumonía por aspiración y embolismo pulmonar 21,22 .…”

A rare case report of oesophagocoloplasty with distal colo-jejunal anastomosis in the management of post corrosive strictures of the oesophagus

“…Nutrition in the treatment of acute corrosive intoxications is one of the most important therapeutic processes that largely contribute to faster recovery, stabilization of biologic, immunologic and metabolic parameters and reduction of length of hospital stay. 8 Later patient had developed long, tight and nonnegotiable oesophageal stricture and was not able to take anything orally. In view of previous history of perforation, attempts of oesophageal dilatation were restricted.…”