title: Laundry detergent pod ingestions: is there a need for endoscopy?
abstract: BACKGROUND
  Laundry detergent pod (LDP) exposures in children have resulted in several referrals to the emergency department. Signs and symptoms can include gastrointestinal symptoms (vomiting, drooling), neurological symptoms (depressed sensorium), or metabolic changes (lactic acidosis). There is limited literature on esophageal injury following LDP ingestions.
  
  
  METHODS
  We reviewed three cases of pediatric LDP ingestions that underwent an upper endoscopy in a tertiary care pediatric hospital. All of our patients were younger than 3 years old. The upper endoscopies revealed superficial esophageal erosions in two patients and erythema in the other. None of the patients had oral burns. Two of them developed swallowing dysfunction. Follow-up upper GI studies were normal.
  
  
  METHODS
  Our three patients ingested laundry detergent pods and all of them developed some degree of esophageal injury despite the absence of oral erythema, ulcers, or swelling. A review of literature suggests LDP exposures are more severe than non-pod detergents. Reasons as to why this may be remain unclear, although investigation into the ingredients and mode of delivery may help us to better understand. In a literature review, no esophageal strictures have been reported after LDP ingestion. We reviewed esophageal injury classification systems in an attempt to predict who may be at greatest risk for stricture based on initial findings.
  
  
  CONCLUSIONS
  Our case series demonstrates it is hard to predict esophageal injury based on signs and symptoms. Based on a literature review, long-term esophageal stricture is unlikely, but if gastrointestinal symptoms persist, it is reasonable to evaluate with an upper endoscopy. Larger studies are needed.
authors.affiliation: University of Alabama, 1600 7th Avenue South Lowder 618, Birmingham, AL, 35233, USA, evogel@uabmc.edu.
authors.forename: Erika
authors.initials: E
authors.lastname: Smith
authors.forename: Erica
authors.initials: E
authors.lastname: Liebelt
authors.forename: Jan
authors.initials: J
authors.lastname: Nogueira
mesh_terms: D002675:Child, Preschool; D003902:Detergents / Q000506:poisoning*; D004636:Emergency Service, Hospital; D004724:Endoscopy; D004947:Esophagus / Q000187:drug effects* / Q000473:pathology; D006801:Humans; D007223:Infant; D008297:Male
chemical_list: D003902:Detergents