Oesophageal and gastric corrosions – diagnostic and therapeutic approach

Summary Introduction: Ingestion of a corrosive substance is an infrequent but serious condition with a possible threat to life. Symptoms and diagnosis: Clinical symptoms of esophageal burns are non-specific and are determined by the degree and extent of injury Subjective symptoms do not lead to a diagnosis without information of corrosive substance ingestion. It is necessary to define the substance and find out information of its local and systemic toxicity. The next step should be an ENT examination to descibe local extent of corrosive injury in the oral cavity, pharynx and larynx and exclude severe injury and oedema of larynx and urgency of tracheostomy or intubation. A flexible endoscopy of the upper digestive tract is essential for further treatment. The aim of the endoscopic examination is to evaluate the extent of changes in the oesophagus and stomach. If GIT perforation is suspected, CT scan of the thorax and abdomen must precede the endoscopy. Treatment: In the presence of obstructive respiratory symptoms, laryngeal edema or severe burns of the airways is necessary to secure the airways as the first step. Wide-spread antibiotics should be used in the case of perforation of the oesophagus, in the third stage corrosions and in lung involvement. Corticoids are not indicated as a prevention of strictures, the only indication is to reduce oedema of the airways. Patient’s nutrition depends on degree and extent of the injury. Patients with I and II.A degree burns are nourished orally, a liquid diet for 48 hours is recommended. In patients with II.B and III. degree oral intake is excluded and nasoenteral tube is inserted for tube feeding. In case of GIT perforation, an acute surgical procedure is indicated. Stenosis of the oesophagus are frequent and severe long-term consequences of severe corrosions and long-term care and repeated interventions to restore of possibility of oral feeding could be indicated. Conclusion: Oesophageal and stomach burns are less frequent injuries. However, due to its severity, it can endanger patient’s life or its quality for long years. Multidisciplinary approach is essential in corrosive injuries management. Key words corrosion – endoscopy – corticoids – nutrition – stricture