APH 2001, 59, 211-218:

Juvenile corrosive esophagitis due to accidental caustic soda ingestion: report on a series of cases, including a four-year follow-up.

M. Manea and G.J. Dinant

Keywords: Esophagitis, exogenic toxicosis, pediatrics

Objectives: To assess the incidence and to evaluate the clinical evolution of juvenile corrosive esophagitis (CE) due to accidental caustic soda ingestion.

Methods: A retrospective case series study- of 46 cases with post caustic esophagitis, hospitalized between 01-01-1994 and 30-11-1994 in the Hospital no.1 in Craiova, Romania.  The evolution of these cases was followed since 1998, in ambulatory settings.

Results: Most cases (80%) occurred among young children between the ages of 0 and 3.  Irrespective of their age, boys were more often involved than girls, probably because of their higher level of curiosity, and the habit of drinking alcohol by young parents, especially in rural areas (where 82% of the patients came from).  Caustic solution is easily confused with alcohol.  Furthermore, caustic products are more frequently used in households in rural areas.  As a result of the custom of general house cleaning before Easter and Christmas, acute esophagitis was found to have a higher incidence in winter and spring.

During the hospitalization period, 24% of the cases were found to be mild forms of CE; 61% were moderate cases (characterized by ulcerative and pseudomembranous mouth lesions and damage to the anterior pillar muscles) and 13% had severe forms.  Severe forms included acute inefficient breathing and edema of the posterior pillar muscles and arithenoids.  One patient had a particularly severe form and died of mediastinal necrosis.  Fourteen days after admission to the hospital, 30 patients had been curred, while 15 cases developed early axial stenosis of the esophagus.

One patient died due to perforation of the esophagus after dilatation.  Over the entire study population of 46 children, no more than 9 cases did not need dilatation.  However, these children developed anemia, respiratory problems, anxiety and behavioral and intellectual problems.

Conclusion: The incidence of the disease is an alarmsignal for Rumania because of its severe and enduring consequences, in particular in young children.  Because cheap alternatives are available, the free sale of caustic solutions should stop immediately.