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esophageal burn

Toxic Ingestions: How to Treat Esophageal Burns

By Kalla A. Gervasio

As hard as parents try, sometimes it is impossible to keep up with young children’s every move. In a split second, any accident can happen, some more dangerous than others, such as when children eat or drink something they should not. In developing countries, many children accidentally ingest corrosive substances such as oven cleaner, bleach, or hydrochloric acid. This is an emergency situation in which a doctor must evaluate whether or not a child’s esophagus has been burned by the ingested substance.

Burns can be identified within 24-48 hours of injury using an instrument called an endoscope to view the esophagus and stomach. If burns are present, they are graded according to Zargar classification on a 0-3 scale. One serious complication of burns is the formation of esophageal stricture, which is an abnormal narrowing of the esophagus making it difficult to swallow. Early treatment of esophageal burns is necessary to prevent the formation of strictures, and typically includes a combination of dilation and stent implantation to widen the esophagus, and corticosteroids to decrease inflammation. However, the use of corticosteroids in treating esophageal burns has been controversial.

In a recent study published in Pediatrics, researchers conducted the first randomized controlled study on the use of corticosteroids in treating esophageal burns in children. A randomized controlled study is one in which patients are randomly assigned to a group that either receives the treatment or intervention being studied or does not receive this treatment. People who do not receive the treatment in question are part of the control group. Researchers studied 83 children with an average age of 4.1 years who had ingested corrosive substances and developed grade IIb esophageal burns as a result. These children were hospitalized and divided into a study group that received methylprednisolone treatment for 3 days (a corticosteroid) along with ranitidine, ceftriaxone, and total parenteral nutrition, and a control group that received all of the above except for methylprednisolone.

Ten days after hospitalization, children in both groups underwent an endoscopy to see if their treatment was working or if any strictures had developed. Out of 42 children receiving corticosteroids, only 4 (10.8%) developed strictures compared to 12 (30%) of 41 children not receiving corticosteroids. Overall, 20.8% of all children in the study developed strictures. However, the percentage of stricture development was only 10.8% in the study group compared to 30% in the control group. Based on these statistics, the investigators found that high doses of corticosteroids such as methylprednisolone may reduce stricture development in children with grade IIb esophageal burns.

 

What this means for you: If you believe that your child has ingested a corrosive substance such as oven cleaner or bleach, take them to the emergency room for immediate evaluation. If tests reveal a type IIb esophageal burn, discuss the possibility of methylprednisolone treatment for your child with your doctor. Corticosteroids may reduce the possibility of your child developing an esophageal stricture secondary to burns.

 

References:

  1. Zargar SA et al. The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns. Gastrointest Endosc. 1991;37(2): 165-169.
  2. Usta, Merve et al. High doses of methylprednisolone in the management of caustic esophageal burns. Pediatrics 2014;133: e1518-e1524.