[Management of caustic esophagitis in children].

Abstract

In children, caustic ingestion is due to accidents at home and inadequate storage of caustic agents. In emergency, it is useful to remove the soiled clothes, rinse the affected area, and prevent vomiting and feeding. Caustic ingestion (pH<2 or>12) induces burns of the upper gastrointestinal tract requiring esophagogastro-duodenoscopy between H12 and H24. Strong alkalis cause necrosis with liquefaction of the esophagus, penetrating deeply with a high-risk of perforation. Management of these children requires a specialized care center with an intensive care unit, endoscopic equipment, and a surgical team. Esophageal stricture is the main complication; no prophylactic treatment (steroids) is effective. Strictures occur after the 3rd week, and barium swallow should be performed by the end of the 1st month. Stricture are often multiple, long, and tortuous; endoscopic dilatation is difficult with a high-rate of perforation and a low-rate of success. In situ application of mitomycin C or injection of triamcinolone could reduce the recurrence rate of stricture. In recalcitrant or recurrent strictures, it is recommended to perform an esophageal replacement using a colonic interposition or a gastric tube. Endoscopy should also be performed 15-20years after caustic ingestion to screen for early neoplastic lesions. Prevention is very important for avoiding caustic ingestions. Information and education should be given specifically to the parents of toddlers; caustic products should be stored out of reach of children and they should not be kept with food.

• Authors: E Mas, A Breton, A Lachaux
• Journal: Archives de pediatrie : organe officiel de la Societe francaise de pediatrie (Arch Pediatr) Vol. 19 Issue 12 Pg. 1362-8 (Dec 2012) ISSN: 1769-664X [Electronic] France
• Vernacular Title: Prise en charge des enfants après ingestion de substances acides ou alcalines.
• PMID: 23141564 (Publication Type: English Abstract, Journal Article, Review)
• Copyright: Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Chemical References

• Caustics
• Glucocorticoids
• Proton Pump Inhibitors

Topics

• Anastomosis, Surgical
• Antibiotic Prophylaxis
• Burns, Chemical (complications)
• Caustics (toxicity)
• Child
• Colon (transplantation)
• Esophageal Stenosis (chemically induced, prevention & control)
• Esophagectomy
• Esophagitis (chemically induced, therapy)
• Esophagoplasty
• Esophagoscopy
• Esophagus (injuries, surgery)
• Glucocorticoids (therapeutic use)
• Humans
• Nutritional Support
• Proton Pump Inhibitors (therapeutic use)