A retrospective analysis of 98 patients, less than 15 years of age, treated for
caustic ingestion during 1976-1990 was performed to evaluate the modern consequences of
caustic ingestion in children and to set indications for esophagoscopies and radiographic and laboratory examinations. Dishwasher
detergents were ingested by 56 children. There were no
lye ingestions, since
lye has not been freely available in Finland since 1969. Household
acetic acid (
vinegar) was the most commonly (12/23) ingested
acid. Primary esophagoscopy was performed in 79 of the 98 cases (80.6%). Esophageal
burns were found in 20 patients.
Acids caused
burns more often than
alkalies (9/23 (39.1%) versus 11/75 (14.7%); p = 0.011; 95% confidence intervals (CI) for the difference 5.6-43.3%) and
acid burns more often developed into
scars (7.4% versus 4%; p = 0.029; 95% CI for the difference 1.4-25.4%). The only
esophageal stricture developed after ingestion of a
Clinitest tablet. The mean time for hospitalization as a result of
acid ingestion was significantly longer than after alkaline ingestion (3.2 (SD 3.5) days, n = 23 versus 1.5 (1.6) days, n = 75; p < 0.05; 95% CI for the difference 0.7-2.8 days). Prolonged
drooling and
dysphagia (12-24 h) predicted esophageal
scar formation with 100% sensitivity and 90.1% specificity, but signs and symptoms did not predict esophageal
burns after primary esophagoscopy. Radiographic examinations and leukocyte counts were of no value in predicting esophageal
burns and
scars. The panorama of
caustic ingestion appears to have changed, probably due in part to the law banning sale of
lye products since 1969. This type of law should be encouraged elsewhere.
Acids cause even more
caustic burns than
alkalies.
Vinegar should be regarded as a potent
caustic substance and distributed in baby-safe bottles with appropriate information on its
caustic nature. As severe esophageal lesions after accidental ingestion of
caustic substances are now rare in children, primary esophagoscopies and hospitalization of patients are not indicated routinely. The decision on esophagoscopy can be made on the basis of
drooling and
dysphagia during follow-up.