JOURNAL ARTICLE

Acute esophageal injury and strictures following corrosive ingestions in a 27year cohort

Timothy Cowan, Robert Foster, Geoffrey K Isbister
American Journal of Emergency Medicine 2017, 35 (3): 488-492
27955797

PURPOSE: We aimed to determine the incidence of esophageal strictures in corrosive ingestions and potential predictors of severe injury.

BASIC PROCEDURES: This was a retrospective cohort study of corrosive ingestions from a toxicology unit (1987-2013) with telephone follow-up at least 1 y post-ingestion. Clinical data and investigations were obtained from a toxicology admission database. The primary outcome was esophageal stricture. Other outcomes included in-hospital mortality, endoscopy grade and early complications.

MAIN FINDINGS: There were 89 corrosive ingestions; median age, 31 y [1-87 y; 46 females], including 13 strong alkalis (pH>12), 8 strong acids (pH<2), 29 domestic bleaches, 30 other domestic products, 6 non-domestic products and three unknown. Three patients died in hospital within 24 h (phenol, sodium azide, HCl). Two developed strictures (both strong alkalis): one had complete esophageal destruction; another developed a stricture after 25 d (inpatient grade 2A endoscopy). 24 patients were asymptomatic and discharged without complication. 65 patients were symptomatic (4 catastrophic injuries). 61 reported sore mouth/throat (50), abdominal pain (21), chest pain (17), dysphagia (13); 28 had an abnormal oropharyngeal examination. 25/61 symptomatic patients underwent inpatient endoscopy: normal (3), grade 1 (5), grade 2 (15) and grade 3 (2). Of 88 patients, 12 died (3 inpatients, 9 unrelated), 28 couldn't be contacted and 48 were contacted after 1.7-24 y, including two with strictures. Five couldn't be interviewed (normal endoscopy (1), no dysphagia (3) and stroke (1). 4/41 interviewed reported dysphagia but no objective evidence of stricture.

PRINCIPAL CONCLUSIONS: All inpatient deaths and severe complications were apparent within hours of ingestion, and occurred with highly corrosive substances. One delayed stricture occurred, not predicted by inpatient endoscopy.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read
27955797
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"