High doses of steroids in the management of caustic esophageal burns in children

Esophageal burns are frequent in some countries. Esophageal stricture is a severe complication after caustic ingestion. Its frequency is estimated to 5% and reaches 47% in severe esophagitis. Aim of the study. - To study the influence of management of severe esophageal bums with high doses of steroids in the occurrence of esophageal stricture through the experience of an endoscopic unit. Patients and methods. - Twenty-six children with a mean age of 3.5 years (15 months-8 years) with a second b- (N = 22) or a third-degree (N = 4) esophageal bums due to accidental ingestion of a caustic substance were included between 1993 and 1999. Corrosive substances ingested were sodium hydroxide (N = 17), bleach (N = 4), alkali (N = 3), others (N = 2). Upper GI endoscopy was performed in 17 children within the 24 hours of caustic ingestion and within the first 48 hours in all cases. All patients received methylprednisolone (1 g/1.73 m(2)/day) plus cimetidine and ampicilin plus early oral feeding resumption. Results. - Three children (2 grade II et one grade I) were not controlled on day 30 of the protocol and have then been excluded. The remaining 23 children were divided in two groups depending on the upper GI endoscopic results: group I of 12 patients completely or partially healed and group II of 11 patients who developed an esophageal stricture. No difference was observed between the two groups with regard to the delay between caustic ingestion and the start of treatment and the number of shots of methylprednisolone. Second b- degree esophagitis complicated with an esophageal stricture underwent a median of five esophageal dilations (1-12). After a median follow-up of three years, four of them have a normal esophagus. All children with a third-degree esophagitis developed an esophageal stricture. One had a surgical replacement of the esophagus with a segment of colon with good outcome. The three others underwent a median of seven esophageal dilations (5-10). One of them has a normal esophagus after a follow-up of five years while the two others were lost to follow-up. Conclusion. - High dose of corticosteroids seems to improve second b-degree esophagitis prognosis and may prevent from esophageal stricture. (C) 2003 Elsevier SAS. Tous droits reserves.