Giovanni Di Nardo1, Pietro Betalli2, Maria Teresa Illiceto3, Giannotti Giulia2, Luigi Martemucci4, Flora Caruso4, Gabriele Lisi5, Giusy Romano6, Maria Pia Villa1, Chiara Ziparo1, Licia Pensabene6, Francesca Vassallo1, Paolo Quitadamo7. 1. NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome. 2. Pediatric Surgery Unit, Ospedale Papa Giovanni XXIII, Bergamo. 3. Pediatric Gastroenterology and Endoscopic Unit "Santo Spirito" Hospital, Pescara. 4. Pediatric Gastroenterology Unit, A.O.R.N. Santobono-Pausilipon, Naples. 5. Department of Pediatric Surgery, University of Chieti-Pescara "Gabriele D'Annunzio" - Santo Spirito Hospital, Pescara. 6. Department of Medical and Surgical Sciences, Pediatric Unit, University "Magna Graecia" of Catanzaro, Catanzaro. 7. Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Naples, Italy.
Abstract
OBJECTIVES: Despite the efforts to reduce the exposure to corrosive household products, caustic ingestion in children is currently a significant medical problem. The aims of the present study were to evaluate the clinical consequences of caustic ingestion and to identify prognostic factors that could concur in driving both diagnostic and therapeutic management. METHODS: All consecutive children referred for ingestion of a caustic substance from June 2017 to June 2018 were enrolled. Medical records, laboratory and endoscopic findings were reviewed and analyzed. RESULTS: We enrolled 44 children with caustic ingestion. Alkaline agents were ingested by 26 of 44 (59.1%) patients, whereas acid agents were ingested by 18 of 44 patients (40.9%). Alkaline rather than acid agents were associated with a worse endoscopic score (r: 0.45) and a higher probability of early esophageal stricture occurrence (r: 0.38). The specific risk of the presence of severe esophageal lesions rose progressively with increasing number of symptoms whereas no esophageal injury was found in asymptomatic patients. CONCLUSIONS: Our data suggest that endoscopic evaluation is mandatory in symptomatic patients to direct therapeutic management, but it could be avoided in asymptomatic patients after accidental ingestion, particularly if the ingestion is only suspected and patients have no oropharyngeal burns.
OBJECTIVES: Despite the efforts to reduce the exposure to corrosive household products, caustic ingestion in children is currently a significant medical problem. The aims of the present study were to evaluate the clinical consequences of caustic ingestion and to identify prognostic factors that could concur in driving both diagnostic and therapeutic management. METHODS: All consecutive children referred for ingestion of a caustic substance from June 2017 to June 2018 were enrolled. Medical records, laboratory and endoscopic findings were reviewed and analyzed. RESULTS: We enrolled 44 children with caustic ingestion. Alkaline agents were ingested by 26 of 44 (59.1%) patients, whereas acid agents were ingested by 18 of 44 patients (40.9%). Alkaline rather than acid agents were associated with a worse endoscopic score (r: 0.45) and a higher probability of early esophageal stricture occurrence (r: 0.38). The specific risk of the presence of severe esophageal lesions rose progressively with increasing number of symptoms whereas no esophageal injury was found in asymptomatic patients. CONCLUSIONS: Our data suggest that endoscopic evaluation is mandatory in symptomatic patients to direct therapeutic management, but it could be avoided in asymptomatic patients after accidental ingestion, particularly if the ingestion is only suspected and patients have no oropharyngeal burns.