Objective Assessment of Superiority of Enteral Feeding by Traditional Home Kitchen-Based Feed V/S Commercial Formula Feed in Patients of Esophagogastric Corrosive Injury

Background: Corrosive ingestion can cause severe chemical injury to upper gastrointestinal tract which leads to dysphagia, malnutrition and weight loss. Early nutritional assessment and support through feeding jejunostomy is important and it should be nutritionally optimum and economically balanced. The aim is to compare cost and nutritional status after nutritional support with traditional home kitchen made and commercial formula feed through feeding jejunostomy.Methods:A prospective study included patients on enteral nutrition based on traditional home kitchen feed (cohort-1) and on commercial formula feed (cohort-2). Patient抯 body weight, BMI, haemoglobin, serum albumin, nutritional risk index, controlling nutritional status score were checked at the admission, 3rd and 6th month follow up.Results: In cohort 1 mean albumin and haemoglobin raised by 33.13% & 14.60% at 3rd month and 47.23% & 22.3% at 6th month respectively; In cohort 2 it was 9.12% & 2.69% at 3rd month and 17.62% & 6.53% at 6th month respectively. At 6th month in cohort 1 and 2 mean weight gain was 7.56% & 4.0%; mean increase in NRI was 34.78% & 11.5% respectively. Mean CONUT score at six months was better improved in cohort 1 which is 6 to 1 as compared to cohort 2 which was 6 to 3. Mean monthly cost of home-based feeds was significantly lower as compared to commercial feeds (62.14 Rs v/s 682-2354 Rs/day).Conclusions:In corrosive GI tract injury patient enteral nutrition with traditional home kitchen-based feeds is safe, cost effective and associated with better improvement in nutritional status objective parameters.

Benign gastric outlet obstruction – spectrum and management.

Intrinsic or extrinsic obstruction of the pyloric channel or duodenum either by benign or malignant diseases leads to gastric outlet obstruction. With improvement in science and technology, the spectrum of gastric outlet obstruction has changed from peptic ulcer disease to corrosives and malignant diseases. Newer investigations like computerized tomography and endoscopy have supplemented the previous clinical tests like saline load test and barium series. Improvised treatment modalities like endoscopic balloon dilatation and endoscopic incision have circumvented the use of surgery which was the gold standard for management of gastric outlet obstruction. Newer modalities like biodegradable stents have an upcoming role in the management.

Corrosive Injury Due to Edible Vinegar

Vinegar is a very popular ingredient used in many cuisines. It is also known for its beneficial health, beauty and possible weight-loss properties. The authors report on a patient who presented to the emergency department with unstable vital signs complaining of generalized abdominal pain after ingestion of 450 ml of apple cider vinegar. We documented a case of corrosive gastrointestinal injury with persistent metabolic acidosis occurring after ingesting apple cider vinegar with an acetic acid concentration of 12~14%. Toxic damage to the liver and kidney were also observed, peaking on post-ingestion day 3. The patient received supportive care and hemoperfusion for three days without much clinical improvement and died in the seventh day of intensive care due to disseminated intravascular coagulation and multi organ failure. Edible vinegar, when taken in large amounts, is capable of inducing corrosive injuries of the GI tract as well as severe systemic toxicities, such as metabolic acidosis. Safety precautions regarding vinegar deserve more public attention and clinicians also should be astute enough to recognize the potential damage accompanying vinegar ingestion.

A Case of Corrosive Injury-Induced Pharyngeal Stricture Treated by Endoscopic Adhesiolysis Using an Electrosurgical Knife

Here, we report a case of corrosive injury-induced pharyngeal stricture in a 69-year-old female, which was successfully treated with endoscopic adhesiolysis using an electrosurgical knife. The patient had ingested sodium hydroxide in an attempted suicide, and immediate endoscopy revealed corrosive injuries of the pharynx, esophagus, and stomach. When a liquid diet was permitted, she complained of nasal regurgitation of food. Follow-up endoscopy revealed several adhesive bands and a web-like scar that did not allow passage of the endoscope into the hypopharyngeal area. For treatment of the hypopharyngeal stricture, the otolaryngologist attempted to perform an excision of the fibrous bands around the esophageal inlet using microscissors passed through an esophagoscope, but this procedure was not effective. We then dissected the mucosal adhesion and incised the adhesive bands using an electrosurgical knife. After this procedure, nasal regurgitation of food no longer occurred. To our knowledge, this case is the first report of endoscopic adhesiolysis with an electrosurgical knife in a patient with a corrosive injury-induced pharyngeal stricture.

Severe Glyphosate Intoxication with a Laryngopharyngeal Corrosive Injury

Glyphosate is an herbicide that is used worldwide. Suicidal attempts with a glyphosate-surfactant herbicides (GlySH) are on the rise. The severity of corrosive injuries is thought to have a close correlation with a higher complication rate or pulmonary aspiration. We report a case with multiple toxic effects associated with a severe laryngopharyngeal corrosive injury following GlySH intoxciation. Specifically, a severe laryngopharyngeal corrosive injury might be significantly associated with the toxic effects and complications, including respiratory failure and chemical pneumonia, bleeding tendency, increased BUN/Cr ratio, and frequent aspiration due to dysphagia. Appropriate evaluation and management of corrosive injuries may be helpful in caring for GlySH-intoxicated patients.

Acetic Acid Induced Laryngitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acetic acid is not uncommon suicidal material and it can cause serious laryngitis. The purpose of this study was to investigate the clinical characteristics, proper management, and clinical course of laryngitis induced by acetic acid. SUBJECTS AND METHOD: We analyzed the medical records of 39 patients with acetic acid ingestion from 1996 to 2006, retrospectively. RESULTS: Flexible fiberoptic laryngoscopy showed supraglottic laryngeal edema or mucosal ulcer with narrowed airway in 15 cases (38.5%). More common reason of ingestion was suicidal attempt than accidental exposure. There was no significant correlation between severity and the amount of ingestion, or the reason of ingestion. Eight patients needed orotracheal intubation for airway management, but no emergency tracheotomy was imperative. Most laryngeal lesions were relieved by supportive care within 2 weeks. CONCLUSION: Acetic acid laryngitis could narrow airway, and could be resolved by supportive management. Flexible fiberoptic laryngoscopy was useful in evaluating laryngeal involvement and severity.

A Clinical Study on the Upper Gastrointestinal Tract Injury Caused by Corrosive Agent / 대한소화기내시경학회지

BACKGROUND/AIMS: The incidence of corrosive injury has been decreased, compared with past years. However, the ingestion of corrosive agent for suicidal attempt is on an increasing trend. Though corrosive injury on gastrointestinal tract is very common, there are few clinical studies on this field. METHODS: Retrospective study was performed on 48 patients who ingested corrosive agent from 1992 to 1998. The kinds of corrosive agent, cause of ingestion, symptoms, gastroscopic findings, treatment and complications were analyzed. RESULTS: The most common agent of ingestion was acetic acid (47.9%), followed by hydrocholoric acid (18.8%), cresol (10.4%), lye (10.4%), sulfuric acid (4.2%). Ingestion for suicidal attempt (60.4%) was more frequent than accidental ingestion (39.6%). The frequent symptoms were sore throat (31.3%), dysphagia (27.1%), epigastric pain (22.9%), vomiting (18.8%), chest pain (18.8%), GI bleeding (12.5%), dyspnea (12.5%) and hematuria (8.3%). The esophagus was the most common site of corrosive injury and Grade IIa injury was the most frequent finding on gastroscopy. In most cases, prophylactic antibiotics with or without steroid was administered for conservative treatment. For long-term sequelae, there were 7 cases (14.6%) of esophageal stricture, and 2 cases (4.2%) of gastric outlet obstruction. CONCLUSIONS: Corrosive injury on gastrointestinal tract is frequently observed on early gastroscopy and can cause significant late sequelae, such as stricture. Therefore, it is necessary to evaluate regular follow up gastroscopy for the management of late sequelae.

Corrosive Injury of the Stomach and Esophagus by Sodium Hypochlorite Ingestion: A case report

Ingestion of sodium hypochlorite bleach is usually benign, leading most emergency departments to advocate conservative home management. We report a rare case of household bleach ingestion. A 54- year-old male ingested unintentionally an unknown quantity of household bleach (4% sodium hypochlorite, pH<12). He was transferred to our department for further evaluation and management from a local general hospital because of continuous vomiting and suspicious gastric malignant lesions on the endoscopic findings. The results of repeated gastrointestinal endoscopy were corrosive injury to the stomach and the esophagus. About 60 days following ingestion of the bleach, he underwent a hemigastrectomy due to pyloric stenosis. The literature regarding corrosive injury following bleach ingestion is reviewed.

The Treatment of Corrosive Injury of Esophagus in Children by Means of Stent / 实用放射学杂志

Objective To study the method of treatment of esophageal stricture and ulcer in children caused by corrosive injury using esophageal stent.Methods The stent made of stainlees steel Z type covered with thin membrane or Ni-Ti shape memory wire mesh-like stent was used and placed through mouth by the transport of tracheal stent in 12 cases.Results Symptoms of the dysphagia in all 12 cases treated with 18 sets of Z stents were alleviated remarkably.Following up study from 6 month to 6 years,the stents were regulated or replaced one or more times in 9 cases,the stents were removed in 5 cases,and food-taking was normal following up from 6 to 36 months.Surgical operation was done in one case.The stents were retained in 6 cases,but ordinary and soft food could be taken without problem.One case was treated with 2 stes of Ni-Ti shape memory wire mesh-like stent,the esophageal stricture reappeared one month later and operation was done 6 years later.Conclusion Stent of the Z type is safe and effective in treating esophageal stricture and ulcer in children caused by corrosive injury.