Esophagitis, corrosive (caustic)
Esophagitis, corrosive (caustic): Excerpt from Handbook of Diseases
Inflammation and damage to the esophagus after ingestion of a caustic chemical is called corrosive or caustic esophagitis. Similar to a burn, this injury may be temporary or lead to permanent stricture (narrowing or stenosis) of the esophagus that requires corrective surgery.
Severe injury can quickly lead to esophageal perforation, mediastinitis, and death from infection, shock, and massive hemorrhage (due to aortic perforation).
Causes
The most common chemical injury to the esophagus follows the ingestion of lye or other strong alkalies; less commonly, injury follows the ingestion of strong acids. The type and amount of chemical ingested determine the severity and location of the damage.
In children, household chemical ingestion is accidental; in adults, it’s usually a suicide attempt or gesture. (See Advice for corrosive esophagitis, page 314.) The chemical may damage only the mucosa or submucosa, or it may damage all layers of the esophagus.
Esophageal tissue damage occurs in three phases: in the acute phase, edema and inflammation; in the latent phase, ulceration, exudation, and tissue sloughing; and in the chronic phase, diffuse scarring.
Signs and symptoms
Effects vary from none to intense pain in the mouth and anterior chest, marked salivation, inability to swallow, and tachypnea. Bloody vomitus that contains pieces of esophageal tissue signals severe damage. Signs of esophageal perforation and mediastinitis, especially crepitation, indicate destruction of the entire esophagus. Inability to speak suggests laryngeal damage.
The acute phase subsides in 3 to 4 days, enabling the patient to eat again. Fever suggests secondary infection. Symptoms of dysphagia return if stricture develops, usually within weeks.
Diagnosis
A history of chemical ingestion and physical examination that reveals oropharyngeal burns (including white membranes and edema of the soft palate and uvula) usually confirm the diagnosis. The type and amount of the chemical ingested must be identified; sometimes this can be done by examining empty containers of the ingested material or by calling the poison control center.
Endoscopy (in the first 24 hours after ingestion) delineates the extent and location of the esophageal injury and assesses the depth of the burn. This procedure may also be performed a week after ingestion to assess stricture development.
Treatment
The patient may be treated conservatively through monitoring his condition, or he may require bougienage or surgery.
Bougienage
This procedure involves passing a slender, flexible, cylindrical instrument called a bougie into the esophagus to dilate it and minimize stricture.
CLINICAL TIP: Some physicians begin bougienage immediately and continue it regularly to maintain a patent lumen and prevent stricture; others delay it for a week to avoid the risk of esophageal perforation.
Surgery
Immediate surgery may be necessary for esophageal perforation; it may also be performed later to correct stricture that isn’t treatable with bougienage. Corrective surgery may involve transplanting a piece of the colon to the damaged esophagus. Even after surgery, stricture may recur at the site of the anastomosis.
Supportive treatment
Other treatment includes I.V. therapy, to replace fluids, and total parenteral nutrition while the patient can’t swallow, gradually progressing to clear liquids and a soft diet.
Special considerations
If you’re the first health care professional to see the person who has ingested a corrosive chemical, the quality of your emergency care is critical. Follow these important guidelines.
❑ Don’t induce vomiting or lavage because this exposes the esophagus and oropharynx to injury a second time.
❑ Don’t perform gastric lavage because the corrosive chemical may further damage the mucous membrane of the GI lining.
❑ Provide vigorous support of vital functions as needed, such as oxygen therapy, mechanical ventilation, I.V. fluids, and treatment for shock, depending on the severity of the injury.
❑ Carefully observe and record intake and output.
❑ Before X-rays and endoscopy, explain the procedure to the patient to lessen anxiety during the tests and to enhance his cooperation.
❑ Teach patients and families how to prevent future incidents of chemical ingestion.
Pictures
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
More About Esophagus diseases
More Medical Textbooks Online about Esophagus diseases
Review other book chapters online related to Esophagus diseases:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
|
|
More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
|
|
» Next page: Surveys relating to Esophagus diseases
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
