title: Acute esophageal injury and strictures following corrosive ingestions in a 27year cohort.
abstract: OBJECTIVE
  We aimed to determine the incidence of esophageal strictures in corrosive ingestions and potential predictors of severe injury.
  
  
  METHODS
  This was a retrospective cohort study of corrosive ingestions from a toxicology unit (1987-2013) with telephone follow-up at least 1 y post-ingestion. Clinical data and investigations were obtained from a toxicology admission database. The primary outcome was esophageal stricture. Other outcomes included in-hospital mortality, endoscopy grade and early complications.
  
  
  RESULTS
  There were 89 corrosive ingestions; median age, 31 y [1-87 y; 46 females], including 13 strong alkalis (pH>12), 8 strong acids (pH<2), 29 domestic bleaches, 30 other domestic products, 6 non-domestic products and three unknown. Three patients died in hospital within 24 h (phenol, sodium azide, HCl). Two developed strictures (both strong alkalis): one had complete esophageal destruction; another developed a stricture after 25 d (inpatient grade 2A endoscopy). 24 patients were asymptomatic and discharged without complication. 65 patients were symptomatic (4 catastrophic injuries). 61 reported sore mouth/throat (50), abdominal pain (21), chest pain (17), dysphagia (13); 28 had an abnormal oropharyngeal examination. 25/61 symptomatic patients underwent inpatient endoscopy: normal (3), grade 1 (5), grade 2 (15) and grade 3 (2). Of 88 patients, 12 died (3 inpatients, 9 unrelated), 28 couldn't be contacted and 48 were contacted after 1.7-24 y, including two with strictures. Five couldn't be interviewed (normal endoscopy (1), no dysphagia (3) and stroke (1). 4/41 interviewed reported dysphagia but no objective evidence of stricture.
  
  
  CONCLUSIONS
  All inpatient deaths and severe complications were apparent within hours of ingestion, and occurred with highly corrosive substances. One delayed stricture occurred, not predicted by inpatient endoscopy.
authors.affiliation: Department of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle, NSW, Australia.
authors.forename: Timothy
authors.initials: T
authors.lastname: Cowan
authors.affiliation: Department of Gastroenterology, John Hunter Hospital, Newcastle, NSW, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Foster
authors.affiliation: Department of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle, NSW, Australia; Clinical Toxicology Research Group, University of Newcastle, NSW, Australia. Electronic address: geoff.isbister@gmail.com.
authors.forename: Geoffrey K
authors.initials: GK
authors.lastname: Isbister
mesh_terms: D000059:Accidents / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002057:Burns, Chemical / Q000150:complications / Q000453:epidemiology*; D002424:Caustics / Q000633:toxicity*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D016145:Endoscopy, Digestive System / Q000706:statistics & numerical data*; D004940:Esophageal Stenosis / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016728:Self-Injurious Behavior / Q000453:epidemiology; D055815:Young Adult
chemical_list: D002424:Caustics
keywords: Acid; Alkali; Caustic ingestion; Corrosive ingestions; Esophageal stricture; Perforation