Editorial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. May 6, 2017; 8(2): 90-98
Published online May 6, 2017. doi: 10.4292/wjgpt.v8.i2.90
Management of esophageal caustic injury
Mark Anthony A De Lusong, Aeden Bernice G Timbol, Danny Joseph S Tuazon
Mark Anthony A De Lusong, Aeden Bernice G Timbol, Danny Joseph S Tuazon, Section of Gastroenterology, Department of Medicine, Philippine General Hospital, University of the Philippines, Manila 01004, Philippines
Author contributions: All authors gathered the available literature; Tuazon DJS made the initial draft; Timbol ABG added the tables, figures, and algorithm and made revisions on the article; De Lusong MAA made critical revisions and final approval of the version to be published.
Conflict-of-interest statement: All authors have no conflict of interest to declare. All authors have seen and approved the manuscript submitted. The article has not received prior publication and is not under consideration for publication elsewhere.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mark Anthony A De Lusong, MD, Section of Gastroenterology, Department of Medicine, Philippine General Hospital, University of the Philippines, Taft Avenue, Manila 01004, Philippines. delusongmd@gmail.com
Telephone: +639-02-5548400-2075 Fax: +639-02-5672983
Received: October 15, 2016
Peer-review started: October 19, 2016
First decision: November 14, 2016
Revised: February 25, 2017
Accepted: March 12, 2017
Article in press: March 14, 2017
Published online: May 6, 2017
Processing time: 200 Days and 18.4 Hours
Abstract

Ingestion of caustic substances and its long-term effect on the gastrointestinal system maintain its place as an important public health issue in spite of the multiple efforts to educate the public and contain its growing number. This is due to the ready availability of caustic agents and the loose regulatory control on its production. Substances with extremes of pH are very corrosive and can create severe injury in the upper gastrointestinal tract. The severity of injury depends on several aspects: Concentration of the substance, amount ingested, length of time of tissue contact, and pH of the agent. Solid materials easily adhere to the mouth and pharynx, causing greatest damage to these regions while liquids pass through the mouth and pharynx more quickly consequently producing its maximum damage in the esophagus and stomach. Esophagogastroduodenoscopy is therefore a highly recommended diagnostic tool in the evaluation of caustic injury. It is considered the cornerstone not only in the diagnosis but also in the prognostication and guide to management of caustic ingestions. The degree of esophageal injury at endoscopy is a predictor of systemic complication and death with a 9-fold increase in morbidity and mortality for every increased injury grade. Because of this high rate of complication, prompt evaluation cannot be overemphasized in order to halt development and prevent progression of complications.

Keywords: Caustic ingestion; Esophageal caustic; Caustic injury; Corrosive ingestion; Esophageal injury

Core tip: Caustic ingestion maintains its place as an important public health issue in spite of the multiple efforts to educate the public. This is due to the ready availability of caustic agents and the loose regulatory control on its production. Substances with extremes of pH are very corrosive and can create severe injury in the upper gastrointestinal tract. Locations most seriously affected are in the esophagus and stomach and may lead to chronic complications like stricture formation, gastric outlet obstruction, and malignant transformation. Prompt evaluation is therefore emphasized in order to halt development and prevent progression of these complications.