Predictors of esophageal stricture in children with unintentional ingestion of caustic agents.
BACKGROUND
Prediction of the severity of esophageal injury following ingestion of a caustic substance is a challenging problem for clinicians. It was hoped that risk factors for the early prediction of esophageal stricture in such patients could be identified in this study.


METHODS
This study comprises an evaluation of 32 children with esophageal injury due to ingestion of caustic materials. Patients' signs and symptoms as well as laboratory data including leukocyte counts and C-reactive protein level were reviewed.


RESULTS
Patients who presented with a greater number of symptoms and signs were inclined to have more severe esophageal injury and stricture. The frequency of symptoms and signs in patients with serious esophageal injury was higher than that in patients with low-grade injury. Patients with severe injury were more significantly associated with the occurrence of stricture. The characteristic of caustic ingestion was associated with esophageal stricture, but not esophageal injury. There was no statistically significant difference in leukocyte counts relative to severity of esophageal injury. The mean of leukocyte counts of patients with esophageal stricture was close to that of patients without esophageal stricture. There was also no statistically significant difference in C-reactive protein values between the 2 groups of patients.


CONCLUSIONS
Leukocyte counts and C-reactive protein are not useful parameters for predicting the severity of esophageal injury and occurrence of stricture following injury to the esophagus by caustic materials. Alkali ingestion more probably leads to esophageal stricture than acid ingestion. After caustic ingestion, the presence of a greater number of symptoms and signs suggests a more-severe injury, which necessitates more-aggressive management.
Chen
Tsung-Yi
TY
Department of Pediatrics, Chang Gung Children's Hospital, Kaohsiung, Taiwan 833, ROC. tsungyi@ms30.url.com.tw
Ko
Sheung-Fat
SF
Chuang
Jiin-Haur
JH
Kuo
Hsin-Wei
HW
Tiao
Mao-Meng
MM
D000293:Adolescent; D002057:Burns, Chemical / Q000097:blood / Q000150:complications*; D002097:C-Reactive Protein / Q000032:analysis; D002424:Caustics / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004940:Esophageal Stenosis / Q000139:chemically induced*; D005260:Female; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D008297:Male; D012189:Retrospective Studies
D002424:Caustics; D002097:C-Reactive Protein