CAUSTIC INGESTION: PREDICTORS OF CLINICAL AND ENDOSCOPIC SEVERITY

Aims:

Ingestion of caustic substances in adulthood carries a risk of necrosis and perforation of the digestive system, which may cause important morbidity and even mortality. We intended to study the relevance of clinical factors in the prediction of severity of caustic injury.

Methods:

We analysed a 7 year cohort of consecutive patients admitted to the emergency department after a caustic ingestion. Endoscopic severity (score>IIa according to Zargar classification), need for hospitalization and esophageal-gastric surgery were considered as outcomes. Statistical analysis was performed with SPSS.

Results:

A total of 118 patients were included, 54% (n = 64) female, with a median age of 53 years. Caustic ingestion was voluntary in 53% (n = 62); in 77% (n = 91) the ingested substance was alkaline and in 18.6% (n = 20) the intake exceeded 100 mL. Esophageal and/or gastric lesions classified as Zargar IIb/IIIa/IIIb were identified in 20% (n = 24) of the cases.41% (n = 48) of the patients were admitted for surveillance/stabilization/treatment and 8.5% (n = 10) required esophageal-gastric surgery. Death occurred in 2 patients. The following variables were statistically significant in the predicting endoscopic severity and hospitalization: voluntary ingestion, acid pH, > 100 mL intake and presence of oropharyngeal lesions (p< 0.05 for all comparisons). Moreover, the presence of dyspnea was a predictor of hospitalization. Acid intake, > 100 mL and the presence of lesions in the oropharynx were significant predictors of esophagogastric surgery (p < 0.05 for all comparisons).

Conclusions:

In this cohort, the clinical impact of caustic ingestion was mainly conditioned by the ingestion of acid content, amount of intake and oropharynx lesions. Since caustic esophagitis/gastritis is an entity with important morbidity and mortality, these are variables to be taken into account in the diagnostic approach and therapeutic strategy in the emergency department.