Histopathologic evaluation of the therapeutic efficacy of water and milk dilution for esophageal acid injury.
OBJECTIVE
To determine whether acid-induced injury to the esophagus is decreased by early dilutional therapy with water or milk.


METHODS
A controlled in-vitro animal model for acid injury to the esophagus was carried out using esophagi harvested from 70 Sprague-Dawley rats of both sexes and weighing 250-350 g. One control and six experimental groups each containing ten esophagi were instilled with 1 mL of 0.5 normal solution of hydrogen chloride (N HCl). Dilution with water or milk was performed at 0, 5, or 30 minutes postinjury in the experimental groups. No dilution was performed with the control group. Specimens were maintained in an oxygenated saline bath for a 60-minute experimental period and then fixed in 10% formalin for histologic evaluation. Injury severity was rated by blinded histopathologic examination using scores of 0 (no injury), 1 (minor), 2 (moderate), and 3 (severe) for the histopathologic categories: cornified epithelial cells (CEs), granular cells (GCs), granular cell nuclei (GNs), and basal cells (BCs). Red blood cells were scored as positive or negative for lysis.


RESULTS
The controls showed the most severe outcomes. Significant differences in injury occurred for all time periods and histopathologic categories, except for the GN/water and BC/milk histopathologic category/treatment groups. However, a linear trend analysis was significant for all histopathologic categories except BC. These analyses support decreased injury in the earlier treated groups. Injury severity was highest in the most superficial cell layer (CE).


CONCLUSIONS
Emergency therapy with water or milk reduces acute acid injury to the esophagus. Earlier treatment is associated with decreased injury severity. This research supports the use of dilutional therapy with water or milk for acute acid injury to the esophagus.
Trauma Research Laboratory, Department of Emergency Medicine, State University of New York-Stony Brook, USA.
C S
CS
Homan
S R
SR
Maitra
B P
BP
Lane
H C
HC
Thode
L
L
Davidson
D000143:Acids / Q000009:adverse effects*; D000818:Animals; D004935:Esophageal Diseases / Q000139:chemically induced / Q000628:therapy*; D004947:Esophagus / Q000293:injuries / Q000473:pathology*; D005260:Female; D015601:Injury Severity Score; D008297:Male; D008892:Milk; D051381:Rats; D017207:Rats, Sprague-Dawley; D014867:Water / Q000008:administration & dosage*
D000143:Acids; D014867:Water