Ingestion of acid and alkaline agents: outcome and prognostic value of early upper endoscopy.
BACKGROUND
Ingestion of caustic substances often leads to severe morbidity and, frequently, death. This study compared complications and survival for patients who ingested an acidic substance, mainly glacial acetic acid, or an alkaline agent.


METHODS
Records for 179 patients hospitalized for ingestion of a caustic agent (85 acid [75 glacial acetic acid], 94 alkali) were reviewed. Mucosal injury, systemic and GI complications, and survival were scored.


RESULTS
Outcome was less favorable for patients who ingested acid compared with those who ingested alkali with respect to mucosal injury (median: grade 2 vs. grade 1; p=0.013), hospital stay (mean: 9.9 vs. 7.2 days; p=0.01), admittance to the intensive care unit (44% vs. 22%; p=0.002), systemic complications (24% vs. 3%; p < 0.001), perforation (6% vs. 0%; p=0.017), and mortality (14% vs. 2%; p=0.003). There was no difference in the development of strictures (acid, 15% vs. alkali, 17%). The grade of mucosal injury at endoscopy was the strongest predictive factor for the occurrence of systemic and GI complications and mortality (relative risk 9: 95% CI[3, 30]). Ten of 29 (34%) patients with strictures were treated by endoscopic dilation alone, whereas the others primarily (n=7) or secondarily (n=11) underwent surgery. One patient with an esophageal stricture died from systemic complications.


CONCLUSIONS
Acid ingestion, particularly glacial acetic acid, is associated with a higher frequency of complications and mortality rate than alkali ingestion. Early endoscopy probably is safe and provides important prognostic information. Endoscopic treatment of caustic-induced strictures is only moderately successful.
Departments of Gastroenterology and Hepatology, Public Health, Surgery, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Jan-Werner
JW
Poley
Ewout W
EW
Steyerberg
Ernst J
EJ
Kuipers
Jan
J
Dees
Rober
R
Hartmans
Hugo W
HW
Tilanus
Peter D
PD
Siersema
D000059:Accidents / Q000401:mortality; D019342:Acetic Acid / Q000008:administration & dosage / Q000633:toxicity*; D000143:Acids / Q000008:administration & dosage / Q000633:toxicity*; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000468:Alkalies / Q000008:administration & dosage / Q000633:toxicity*; D002057:Burns, Chemical / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D002423:Cause of Death; D002648:Child; D004939:Esophageal Perforation / Q000139:chemically induced / Q000175:diagnosis / Q000401:mortality; D004940:Esophageal Stenosis / Q000139:chemically induced / Q000175:diagnosis / Q000401:mortality; D004945:Esophagoscopy; D004947:Esophagus / Q000293:injuries* / Q000473:pathology; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000293:injuries / Q000473:pathology; D009426:Netherlands; D011379:Prognosis; D013405:Suicide / Q000706:statistics & numerical data; D015996:Survival Rate; D014456:Ulcer / Q000139:chemically induced / Q000175:diagnosis / Q000401:mortality
D000143:Acids; D000468:Alkalies; D019342:Acetic Acid