title: Clinical evaluation and management of caustic injury in the upper gastrointestinal tract in 95 adult patients in an urban medical center.
abstract: BACKGROUND
  Caustic ingestion causes a wide spectrum of injuries; appropriate treatment varies according to the severity and extent of the injury. This retrospective study of adult patients with caustic injury presents the endoscopic findings, treatment regimen, and clinical outcome.
  
  
  METHODS
  Over a 28-year period, 95 consecutive adult patients admitted to an urban emergency hospital for ingestion of caustic materials were studied. Each patient underwent early endoscopy and the injury was graded for severity. There were 61 men and 34 women with an average age of 37.2 years (range 17 to 81). Ingestion was due to a suicide attempt in 49 patients and accidental in 46 patients.
  
  
  RESULTS
  Ten patients showed no mucosal damage. The remaining 85 patients had grade I superficial injury in 47 patients, grade II moderate injury in 25 patients, and deep grade III injury in 13 patients. The ingestion of strong acid or strong alkali often produced deep grade III changes while bleach, detergent, ammonia or other substances usually caused grade I injury. Operative interventions were required for 11 patients with grade III injury and 6 patients with grade II injury. Endoscopic grading was predictive for the onset of complications including late esophageal stricture. There were no complications due to endoscopy; one patient with grade III and multiple comorbidities died from multiple organ failure.
  
  
  CONCLUSIONS
  Upper gastrointestinal endoscopy after caustic ingestion should be performed early to define the extent of injury and guide appropriate therapy. Grade I injuries heal spontaneously. Grade II injuries may be treated conservatively but repeat endoscopy helps define when intervention is needed. Grade III injuries ultimately require surgical intervention.
authors.affiliation: Department of Surgery, Wayne State University, 6C-UHC, 4201 St. Antoine, Detroit, MI 48201, USA. genkipapa178@yahoo.co.jp
authors.forename: Gen
authors.initials: G
authors.lastname: Tohda
authors.forename: Choichi
authors.initials: C
authors.lastname: Sugawa
authors.forename: Christopher
authors.initials: C
authors.lastname: Gayer
authors.forename: Akiko
authors.initials: A
authors.lastname: Chino
authors.forename: Timothy W
authors.initials: TW
authors.lastname: McGuire
authors.forename: Charles E
authors.initials: CE
authors.lastname: Lucas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002057:Burns, Chemical / Q000473:pathology* / Q000628:therapy*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D041742:Upper Gastrointestinal Tract / Q000293:injuries*; D014505:Urban Population