Caustic ingestions

Severe caustic ingestions are uncommon events in most emergency departments, but may produce devastating damage. Minor ingestions with no oro-pharyngeal signs or symptoms (drooling, dysphagia, visible mouth lesions or airway embarrassment) can be safely observed without endoscopy. Early endoscopy should be planned for any patient who has signs or symptoms unless there is free air on X-ray or evidence of severe damage requiring surgical intervention. Antibiotics are useful in grade 2 lesions or worse. Regular corticosteroids are of no proven benefit; however, dexamethasone at 1 mg/kg/day may be beneficial. Stenting of the esophagus to maintain a reasonable lumen appears to be beneficial. Dilation of the esophagus may be started by 3–4 weeks with caution. Endoscopically placed balloon dilators or a guidewire for a Savory dilator should be used. Blind dilation attempts have a high risk of perforation. Chronic problems with esophageal motility, re-stenosis, acid reflux, and psychological difficulties may last a lifetime. The ideal treatment is not yet at hand.