Risk factors for stricture development after caustic ingestion.
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.
Nunes
Amadeu C R
AC
Department of Gastroenterology, University Hospitals of Coimbra, Portugal. ascrnunes@hotmail.com
Romãozinho
José M
JM
Pontes
José M
JM
Rodrigues
Vitor
V
Ferreira
Manuela
M
Gomes
Dário
D
Freitas
Diniz
D
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
D002424:Caustics