Ingestion of acid and alkaline agents: outcome and prognostic value of early upper endoscopy

Background. Ingestion of caustic substances often leads to severe morbidity and, frequently, death. This study compared complications and survival for patients who ingested an acidic substance, mainly glacial acetic acid, or an alkaline agent. Methods: Records for 179 patients hospitalized for ingestion of a caustic agent (85 acid [75 glacial acetic acid], 94 alkali) were reviewed. Mucosal injury, systemic and GI complications, and survival were scored. Results: Outcome was less favorable for patients who ingested acid compared with those who ingested alkali with respect to mucosal injury (median: grade 2 vs. grade 1; p = 0.013), hospital stay (mean: 9.9 vs. 7.2 days; p = 0.01), admittance to the intensive care unit (44% vs. 22%; p = 0.002), systemic complications (24% vs. 3%; p < 0.001), perforation (6% vs. 0%; p = 0.017), and mortality (14% vs. 2%; p = 0.003). There was no difference in the development of strictures (acid, 15% vs. alkali, 17%). The grade of mucosal injury at endoscopy was the strongest predictive factor for the occurrence of systemic and GI complications and mortality (relative risk 9: 95% CI[3, 30]). Ten of 29 (34%) patients with strictures were treated by endoscopic dilation alone, whereas the others primarily (n = 7) or secondarily (n = 11) underwent surgery. One patient with an esophageal stricture died from systemic complications. Conclusions: Acid ingestion, particularly glacial acetic acid, is associated with a higher frequency of complications and mortality rate than alkali ingestion. Early endoscopy probably is safe and provides important prognostic information. Endoscopic treatment of caustic-induced strictures is only moderately successful.