When caustic ingestion occurs, it can burn the upper GI tract tissues oftentimes resulting to gastric or esophageal perforation. The symptoms usually include dysphagia, drooling and pain in the mouth, chest or the stomach as well as the development of strictures later on.
Globally, caustic ingestion typically occurs among young children. Take note that these are usually by accident involving small amounts and often harmless. Among adults, caustic ingestion can be intentional involving large amounts by suicidal individuals and can be life-threatening. The usual sources of caustics include liquid and solid drain and toilet bowl cleaners. Even industrial products are highly concentrated than household products, thus likely to cause even more damage.
How caustic ingestion occurs
The acids in caustic substances can lead to coagulation necrosis where an eschar forms, thus limiting further damage. The acids usually affect the stomach more than the esophagus.
Alkalis can cause fast liquefaction necrosis where there is no eschar formation and damage progresses until the alkali is diluted or neutralized. These substances usually affect the esophagus more than the stomach but ingestion of large amounts can severely affect both.
What are the indications?
The initial symptoms of caustic ingestion include dysphagia and drooling. When it comes to severe cases, other symptoms can occur such as vomiting, pain and bleeding in the mouth, throat, abdomen or chest. The burns in the airways can lead to stridor, coughing and even tachypnea.
Perforation of the esophagus can result to mediastinitis along with intense chest pain, fever, tachycardia, tachypnea and shock. If the stomach is perforated, it can result to peritonitis. The perforation of both can occur within hours, weeks or any time in between.
After several weeks, esophageal strictures can develop even if the primary symptoms are relatively mild and proper treatment has been provided.
Since the presence or absence of internal burns does not dependably indicate whether the stomach or esophagus have been burned, endoscopy is required to check for the presence and severity of the esophageal and gastric burns.
The main focus is avoidance of gastric emptying and oftentimes dilution using oral fluids. Remember that the treatment of caustic ingestion is supportive.
Gastric emptying is not appropriate since it exposes the upper GI tract to the caustic substance again.
Dilution using water or milk is only useful during the first few minutes after ingestion of the liquid caustic, but delayed dilution can be beneficial for ingesting a solid caustic. Take note that dilution must be avoided if the individual has drooling, nausea, stridor or abdominal distention. Perforation of the stomach or esophagus are managed with antibiotics and surgery.