title: Risk factors for stricture development after caustic ingestion.
abstract: OBJECTIVE
  Stricture of the upper digestive tract is the most feared sequelae of caustic ingestion. Determinant risk factors for its development are not entirely known. The aim of this study was to investigate the risk factors associated with the development of fibrotic strictures induced by caustic ingestion.
  
  
  METHODS
  Clinical, laboratory, radiological and endoscopic data from 48 patients admitted to our department for caustic ingestion were reviewed. All cases were submitted to emergency endoscopy and caustic lesions were graded according to Zargar's classification. Twenty-three patients with severe endoscopic lesions (grade IIb/grade III) and/or acute severe complications (gastrointestinal bleeding, respiratory failure) were admitted to an intensive care unit. After hospital discharge, all patients were followed-up (mean follow-up time: 4.1 +/- 1.8 years).
  
  
  RESULTS
  Twelve patients (25%) developed caustic strictures. Four patients (8%) were submitted to surgery for stricture resolution. Factors significantly associated with development of caustic stricture were hematemesis (p = 0.002), serum lactic dehydrogenase > 600 U/L (p = 0.008), grade III lesions (p = 0.0002) and involvement of the entire esophagus (p = 0.0003).
  
  
  CONCLUSIONS
  Severe endoscopic lesions, involvement of the entire length of the esophagus, hematemesis and increased serum lactic dehydrogenase represent risk factors for the development of fibrotic strictures induced by caustic ingestion. Assessment of these parameters may contribute to prevent this complication.
authors.affiliation: Department of Gastroenterology, University Hospitals of Coimbra, Portugal. ascrnunes@hotmail.com
authors.forename: Amadeu C R
authors.initials: AC
authors.lastname: Nunes
authors.forename: José M
authors.initials: JM
authors.lastname: Romãozinho
authors.forename: José M
authors.initials: JM
authors.lastname: Pontes
authors.forename: Vitor
authors.initials: V
authors.lastname: Rodrigues
authors.forename: Manuela
authors.initials: M
authors.lastname: Ferreira
authors.forename: Dário
authors.initials: D
authors.lastname: Gomes
authors.forename: Diniz
authors.initials: D
authors.lastname: Freitas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002057:Burns, Chemical / Q000150:complications* / Q000175:diagnosis; D002424:Caustics / Q000009:adverse effects*; D016009:Chi-Square Distribution; D016099:Endoscopy, Gastrointestinal; D004940:Esophageal Stenosis / Q000139:chemically induced* / Q000175:diagnosis; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D002424:Caustics