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Therapy of caustic ingestion: new treatment considerations

Shub, Mitchell D.

doi: 10.1097/MOP.0000000000000257
GASTROENTEROLOGY AND NUTRITION: Edited by Robert Wyllie
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Purpose of review This review will focus on therapeutic considerations and recent advances in treatment of caustic ingestion injuries.

Recent findings A retrospective study suggests that it may be safe to advance the endoscope beyond the first circumferential burn to allow for a more complete assessment of extent of injury. A randomized controlled prospective study suggested that a 3-day course of high-dose methylprednisolone might reduce the occurrence of esophageal stricture formation. Balloon dilatation has been shown to be as effective as other bougienage techniques with lower risk of perforations. Recent studies indicate that esophageal dilatation can be safely performed as early as 5–15 days after initial ingestion and may decrease risk for long-term stricture formation. The use of adjunctive treatment, such as topical mitomycin C and esophageal stents, shows promise in reducing the reoccurrence of stricture formation after dilatation.

Summary Caustic ingestion remains a significant problem in children, despite continued efforts to educate the public about ways to avoid this preventable accident. Because there are few good quality therapeutic trials in children, many of the current recommendations regarding treatment are based on expert opinion. Large, prospective, multicenter, controlled treatment trials are needed to identify the best protocols to prevent serious complications.

Division of Pediatric Gastroenterology, Phoenix Children's Hospital, Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA

Correspondence to Mitchell D. Shub, MD, Division of Pediatric Gastroenterology, Phoenix Children's Hospital, 1919 East Thomas Rd., Phoenix, AZ 85016, USA. Tel: +1 602 933 0940; e-mail: mshub@phoenixchildrens.com

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