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Controversies in the management of caustic ingestion injury: an evidence-based review.

BACKGROUND: Caustic ingestion of acid or alkaline substances can cause damage to the upper respiratory and upper digestive tract. Initial presentation following caustic ingestion can include oropharyngeal pain, dysphagia and stridor. It is due to this clinical presentation that the resident otolaryngologist is consulted to review and examine these patients to assess for airway compromise and commence initial management and care until airway concern has passed.

OBJECTIVE OF REVIEW: This review aims to provide evidence-based guidance in the management of those presenting with acute ingestion injury so that informed initial medical therapy can be commenced and appropriate investigations are arranged to optimize patient outcome.

TYPE OF REVIEW AND SEARCH STRATEGY: A literature review searched PubMed citing variations on the areas of controversies with 'caustic ingestion', 'corrosive ingestion', 'acid ingestion' and 'alkali ingestion' - from 1956 to present with language restrictions.

EVALUATION METHOD: The bibliographies of articles were searched for relevant references. The references were then compiled and reviewed independently by two authors (JB and SK), overseen by the senior authors (CP and JR). The review process was conducted independently, with the results then collated, with the aim of identifying the highest levels of evidence in each of the areas of controversy.

RESULTS: Over 100 full-text articles were retrieved. Several specific areas of controversy were identified and addressed, with the highest available evidence referenced for each area.

CONCLUSIONS: In caustic ingestion injury, the urgent assessment of the airway is the first priority with a definitive airway secured in those with airway compromise. In those patients with a stable airway and no clinical or radiological sign of perforation, then medical therapy should be commenced and an urgent oesophagogastroduodenoscopy (OGD) is arranged and this should take place within the first 24 h to grade the degree of injury and establish long-term prognosis. In suspected perforation, a surgical opinion should be sought. For those adults who are asymptomatic following ingestion an OGD may not be necessary; however, asymptomatic paediatric patients should be treated with more caution and a period of observation is important. Those who are at risk of developing late complications must be followed up.

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