Steroids in second degree caustic burns of the esophagus: a systematic pooled analysis of fifty years of human data: 1956-2006.
OBJECTIVE
Although steroids are usually withheld in grades I and III esophageal burns, controversy continues regarding their use in grade II burns. Two analyses, including data from 1956-1991 and 1991-2003, respectively, disagreed in their therapeutic recommendations. Our objective is to re-evaluate the usefulness of steroids in grade II burns.


METHODS
The two previous analyses and their references were reviewed. Medline was searched for additional recent human reports. Inclusion criteria were endoscopically documented grade II burns and at least ten days of steroids or no steroids. Pooled data were evaluated by X(2) test with alpha set at 0.05.


RESULTS
Prior analyses identified 12 studies, and one additional study was found during the literature search for a total of 328 patients. 30/244 patients receiving steroids and 16/84 patients who did not receive steroids developed strictures, respectively. This difference was not statistically significant. Heterogeneity of the data prevented formal metanalysis.


CONCLUSIONS
Although methodologically limited, the existing data fail to support the use of steroids in patients with caustic-induced grade II esophageal burns.
Fulton
Jessica A
JA
New York University and Bellevue Hospital Center and Consultant, New York City Poison Control Center. New York, New York. USA. jessicafulton@yahoo.com
Hoffman
Robert S
RS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002057:Burns, Chemical / Q000188:drug therapy* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D003627:Data Interpretation, Statistical; D004945:Esophagoscopy; D004947:Esophagus / Q000293:injuries* / Q000473:pathology; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use*
D000893:Anti-Inflammatory Agents; D013256:Steroids