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Esophagitis Corrosive (Caustic)

Inflammation and damage to the esophagus after ingestion of a caustic chemical is called corrosive or caustic esophagitis. Similar to a bum, this injury may be temporary or lead to permanent stricture (narrowing or stenosis) of the esophagus that requires corrective surgery.

Severe injury can quickly lead to esophageal perforation, mediastinitis, and death from infection, shock, and massive hemorrhage (due to aortic perforation).

Causes

The most common chemical injury to the esophagus follows the ingestion of lye or other strong alkalies; less often, injury follows the ingestion of strong acids. The type and amount of chemical ingested determine the severity and location of the damage.

In children, household chemical ingestion is accidental; in adults, it's usually a suicide attempt or gesture.The chemical may damage only the mucosa or submucosa, or it may damage all layers of the esophagus.

Esophageal tissue damage occurs in three phases: in the acute phase, edema and inflammation; in the latent phase, ulceration, exudation, and tissue sloughing; and in the chronic phase, diffuse scarring.

Signs and symptoms

The main symptom of reflux esophagitis is heartburn , with or without regurgitation of gastric contents into the mouth, which worsens on bending over. Complications of GERD include esophagitis and possibly massive but limited hemorrhage.

Diagnosis

A history of chemical ingestion and physical examination that reveals oropharyngeal bums (including white membranes and edema of the soft palate nnd uvula) usually confirm the diagnosis. The type and amount and chemical ingested must be identified; sometimes this can be done by examining empty containers of the ingested material or by calling the poison control center. Endoscopy (in the first 24 hours after ingestion) delineates the extent and location of the esophageal injury and assesses the depth of the bum. This procedure may also be performed a week after ingestion to assess stricture development.

Treatment

Conservative treatment may be effective, or the patient may require bougienage or surgery.

Conservative treatment

The usual treatment for corrosive esophagitis and stricture includes monitoring the patient's condition.

Bougienage

This procedure involves passing a slender, flexible, cylindrical instrument called a bougie into the esophagus to dilate it and minimize stricture.

CLINICAL TIP Some doctors begin bougienage immediately and continue it regularly to maintain a patent lumen and prevent stricture; others delay it for a week to avoid the risk of esophageal perforation.

Surgery

Immediate surgery may be necessary for esophageal perforation; it may also be performed later to correct stricture that is not treatable with bougienage. Corrective surgery may involve transplanting a piece of the colon to the damaged esophagus. Even after surgery, stricture may recur at the site of the anastomosis.

Supportive treatment

Other treatment includes I. V. therapy to replace fluids and total parenteral nutrition while the patient can't swallow, gradually progressing to clear liquids and a soft diet.