Predictors of Esophageal Stricture in Children with Unintentional Ingestion of Caustic Agent

Background: Prediction of the severity of esophageal injury following ingestion of a causticsubstance is a challenging problem for clinicians. It was hoped that riskfactors for the early prediction of esophageal stricture in such patients couldbe identified in this study.Methods: This study comprises an evaluation of 32 children with esophageal injurydue to ingestion of caustic materials. Patients' signs and symptoms as well aslaboratory data including leukocyte counts and C-reactive protein level werereviewed.Results: Patients who presented with a greater number of symptoms and signs wereinclined to have more severe esophageal injury and stricture. The frequencyof symptoms and signs in patients with serious esophageal injury was higherthan that in patients with low-grade injury. Patients with severe injury weremore significantly associated with the occurrence of stricture. The characteristicof caustic ingestion was associated with esophageal stricture, but notesophageal injury. There was no statistically significant difference in leukocytecounts relative to severity of esophageal injury. The mean of leukocytecounts of patients with esophageal stricture was close to that of patients withoutesophageal stricture. There was also no statistically significant differencein C-reactive protein values between the 2 groups of patients.Conclusions: Leukocyte counts and C-reactive protein are not useful parameters for predictingthe severity of esophageal injury and occurrence of stricture followinginjury to the esophagus by caustic materials. Alkali ingestion more probablyleads to esophageal stricture than acid ingestion. After caustic ingestion,the presence of a greater number of symptoms and signs suggests a moresevereinjury, which necessitates more-aggressive management.