2017-18 HSC Section 3 Green Book

Reprinted by permission of Curr Opin Pediatr. 2015; 27(5):609-613.

REVIEW

C URRENT O PINION

Therapy of caustic ingestion: new treatment considerations

Mitchell D. Shub

Purpose of review This review will focus on therapeutic considerations and recent advances in treatment of caustic ingestion injuries. Recent findings A retrospective study suggests that it may be safe to advance the endoscope beyond the first circumferential burn to allow for a more complete assessment of extent of injury. A randomized controlled prospective study suggested that a 3-day course of high-dose methylprednisolone might reduce the occurrence of esophageal stricture formation. Balloon dilatation has been shown to be as effective as other bougienage techniques with lower risk of perforations. Recent studies indicate that esophageal dilatation can be safely performed as early as 5–15 days after initial ingestion and may decrease risk for long-term stricture formation. The use of adjunctive treatment, such as topical mitomycin C and esophageal stents, shows promise in reducing the reoccurrence of stricture formation after dilatation. Summary Caustic ingestion remains a significant problem in children, despite continued efforts to educate the public about ways to avoid this preventable accident. Because there are few good quality therapeutic trials in children, many of the current recommendations regarding treatment are based on expert opinion. Large, prospective, multicenter, controlled treatment trials are needed to identify the best protocols to prevent serious complications. Keywords caustic, endoscopy, pediatric, stricture, treatment

INTRODUCTION Caustic ingestion in children remains a significant medical problem despite efforts to reduce exposure to corrosive household products. Most ingestions are accidental and occur in children below 6 years of age. Teenagers are also at risk but ingestions in this age group are often purposeful with the motive of being self-harm. Although the number of exposures to household cleaning substances has progressively decreased since 2008, data from 2013 indicate that there were 196,183 human exposures reported to Poison Control Centers’ National Poison Data System [1]. Children below 6 years of age accounted for 113,872 of these exposures (58%) with the vast majority being accidental. CLINICAL MANIFESTATIONS The likelihood that ingestion will result in a serious burn injury is dependent on several factors includ- ing pH, concentration, amount consumed, and

length of contact time with the mucosa. Depending on the type of ingestion, the event may result in a medical emergency requiring immediate interven- tion [2]. In general, alkaline substances tend to be more palatable than acidic products; which often result in the ingestion of larger quantities and increased risk of serious injury [3 & ]. Studies have shown that the presence or absence of symptoms is not an accurate predictor of whether a caustic ingestion has taken place or if serious damage has occurred [4,5,6 & ]. In addition, the presence or Division of Pediatric Gastroenterology, Phoenix Children’s Hospital, Department of Child Health, University of Arizona College of Medi- cine-Phoenix, Phoenix, Arizona, USA Correspondence to Mitchell D. Shub, MD, Division of Pediatric Gastro- enterology, Phoenix Children’s Hospital, 1919 East Thomas Rd., Phoenix, AZ 85016, USA. Tel: +1 602 933 0940;

e-mail: mshub@phoenixchildrens.com Curr Opin Pediatr 2015, 27:609–613 DOI:10.1097/MOP.0000000000000257

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