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Predictability of gastroesophageal caustic injury from clinical findings: is endoscopy mandatory in children?

Boskovic, Aleksandra; Stankovic, Ivica

European Journal of Gastroenterology & Hepatology: May 2014 - Volume 26 - Issue 5 - p 499–503
doi: 10.1097/MEG.0000000000000060
Original Articles: Gastro-oesophageal Disorders

Introduction The aim of this study was to present our patients with corrosive ingestion retrospectively, to analyze the validity of clinical signs as predictors of outcome, and to emphasize the necessity of esophagogastroduodenoscopy.

Materials and methods Data were evaluated from the medical records of patients admitted at the Mother and Child Health Care Institute, Serbia over a 10-year period.

Results A total of 176 children, mean age 36.2±18.1 months (range 9 months to 18 years), with corrosive ingestion were evaluated. The ingested substances were alkali in 96 cases (54.5%), acid in 41 (23.3%), and others in 39 cases (22.1%). In all, 116 patients (65.9%) were symptom free on admission. Positive clinical findings were observed in 60 (34.1%) patients. Upper endoscopy was performed in all children within the first 48 h. Ninety-five patients (54%) had normal endoscopic evaluation, 54 (30.6%) had mild lesions, and 27 (15.3%) had severe corrosive injuries. The validity of clinical findings in predicting the severity of esophageal and gastric injury was as follows: sensitivity – 74 and 75% and specificity – 73 and 68%, retrospectively. Eighteen patients (10.2%) developed esophageal stricture.

Conclusion Endoscopy is a mandatory technique in children with gastroesophageal caustic injuries, and should be performed to prevent unnecessary hospitalization and to plan future treatment. This study emphasizes that clinical signs and symptoms are not predictors of esophageal and gastric injury and that the absence of any clinical findings does not rule out a severe esophageal or gastric injury.

Department of Gastroenterology and Hepatology, Mother and Child Health Care Institute, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Correspondence to Aleksandra Boskovic, MD, Department of Gastroenterology and Hepatology, Mother and Child Health Care Institute, Faculty of Medicine, University of Belgrade, Radoja Dakica 6-8, 11070 Belgrade, Serbia Tel: +381 112 694 533; fax: +381 113 473 324; e-mail: aleksandra.bosko@gmail.com

Received December 13, 2013

Accepted January 15, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins