Caustic Ingestion in Children. One Year Experience in Three Italian Referral Centers

Objectives: Despite the efforts to reduce the exposure to corrosive household products, caustic ingestion in children is currently a significant medical problem. The aims of the present study were to evaluate the clinical consequences of caustic ingestion and to identify prognostic factors that could concur in driving both diagnostic and therapeutic management. Methods: All consecutive children referred for ingestion of a caustic substance from June 2017 to June 2018 were enrolled. Medical records, laboratory and endoscopic findings were reviewed and analyzed. Results: We enrolled 44 children with caustic ingestion. Alkaline agents were ingested by 26/44 (59.1%) patients, while acid agents were ingested by 18/44 patients (40.9%). Alkaline rather than acid agents were associated with a worse endoscopic score (r:0.45) and a higher probability of early esophageal stricture occurrence (r:0.38). The specific risk of the presence of severe esophageal lesions rose progressively with increasing number of symptoms while no esophageal injury was found in asymptomatic patients. Conclusions: Our data suggest that endoscopic evaluation is mandatory in symptomatic patients to direct therapeutic management, but it could be avoided in asymptomatic patients after accidental ingestion, particularly if the ingestion is only suspected and patients have no oropharyngeal burns.