2017-18 HSC Section 3 Green Book

HAIR RELAXERS: A BENIGN CAUSTIC INGESTION?

common. The few published studies describing the clini- cal or endoscopic outcome of the ingestion of hair re- laxer suggest that mucosal injury is uncommon (1,5,10– 13). To further explore the relative frequency of hair re- laxer ingestion, the incidence of associated upper GI mu- cosal injury, and the potential for adverse clinical sequel- ae, we examined all caustic ingestions at Rainbow Ba- bies & Children’s Hospital between 1990 and 2001.

XP20 endoscopes were chosen and for patients greater than 11 years old, the P140 or the Q140 endoscope were used (Olym- pus America, Inc., Melville, NY).

Clinical Outcome Lip, oral, and pharyngeal burns were defined as erythema, edema, or blistering at each respective site. The gross appear- ance of esophageal and gastric mucosal injury was scored by a standardized scale (8,14): Grade 0—no mucosal abnormalities; Grade 1— edema and/or hyperemia limited to the superficial mucosa; Grade 2—erosions, superficial ulcerations, hemor- rhage with or without eschar; Grade 3—multiple ulcerations and/or areas of necrosis. Grades 0 and 1 have not been asso- ciated with adverse clinical outcomes. A small percentage of patients with Grade 2 mucosal injury have clinically relevant sequelae. Scarring, stricture, and perforation are most com- monly associated with Grade 3 injury (1,8,10,15–17). As clini- cal consequences following a caustic ingestion typically be- come apparent within four to eight weeks, we defined adverse clinical outcome as any GI complaint evaluated during a follow-up visit recorded within that time frame (13). Literature Review of Hair-Relaxer Ingestions Using appropriate keywords (hair relaxer, caustic, ingestion, child, esophagus), a Medline search was performed to compile the clinical outcomes on hair relaxer ingestions published in the literature. The cohort data was combined with our study cohort and evaluated for clinical presentation, endoscopic findings, and sequelae. Data Analysis Data on patient demographics, clinical presentation, endo- scopic findings, and clinical outcomes were captured through retrospective chart review. We then pooled our patient cohort with all published patients with hair relaxer ingestion to more accurately estimate the frequency of significant clinical and

METHODS Patients

Patients were identified by querying the hospital Interna- tional Code of Diseases (ICD-9) Meta-Charms Database (Meta, Chicago, IL) for all caustic ingestions (codes 983.2, 983.9, 976.4) admitted to Rainbow Babies & Children’s Hospital be- tween January 1990 and January 2001. Caustic Substances Caustic ingestion was defined as the consumption of an al- kaline or acidic substance capable of inducing upper GI mu- cosal injury. Ingestions were categorized as hair relaxer, house- hold bleach, drain cleaner, household cleaner, or other (any caustic substance that was ingested by no more than three pa- tients). The pH of three brands of hair relaxer was determined using an Orion Research digital pH meter model 611. Esophagogastroduodenoscopy Esophagogastroduodenoscopies (EGD) for caustic inges- tions were routinely performed 12 to 24 hours following the exposure, under general anesthesia or deep conscious sedation, with a flexible endoscope appropriate to the size and the age of the child. For children less than 11 years old, either the P140 or

FIG. 1. Frequency of various caustic substances in- gested in the pediatric population.

J Pediatr Gastroenterol Nutr, Vol. 36, No. 1, January 2003

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