Factors associated with severe mucosal injury of esophagogastroduodenoscopy after caustic substance ingestion in pediatrics

ABSTRACT

OBJECTIVE: To determine the prevalence of and factors associated with severe mucosal injury on esophagogastroduodenoscopy (EGD) after caustic ingestion. METHODS: Consecutive patients ?19 years old with history of caustic ingestion were included. Factors considered were age, sex, caustic agent (acid or alkali) and presence of signs/symptoms (oral lesions, drooling, vomiting, abdominal pain, dysphagia).  RESULTS: 320 patients were investigated 155 (48%) accidental and 165 (52%) intentional case. In accidental intake, majority (84%) were ?6 years old [mean(SD) age 3.7 (4.3) yrs, 59% males]. 10% had severe mucosal injury. The odds of severe injury increased in the presence of ?2 signs/symptoms OR=7.0 for 2 and OR=62.2 for >2. In intentional cases, the mean (SD) age was 16 (1.6) years, 74% females. Severe mucosal injury was seen in 5% and associated with acidic agent (OR=54.8). CONCLUSIONS: Severe mucosal injury on EGD occured in 10% and 5% among accidental and intentional cases, respectively. In accidental cases, probability of severe injury increased in the presence of ?2 signs/symptoms. In intentional cases, acid intake was the only factor associated with severe injury. In the local setting, presence of these factors among patients with caustic ingestion will help identify high-risk patients who need EGD-guided management.