Caustic Esophagitis

• Starting in 1967, lye (concentrated sodium hydroxide) became available as a liquid in drain cleaners and caustic esophagitis became a serious medical problem

Other household agents which can produce caustic esophagitis are acids, ammonium chloride, phenols and silver nitrate

• Lye produces tissue damage through liquefaction necrosis as opposed to acids which produce coagulative necrosis. Both acidic and alkaline agents can damage esophagus.

• There are 3 phases to caustic esophagitis:

• The acute necrotic phase (1-4 days)

• The ulceration-granulation phase (3-5 days)*

• Fibrosis and stricture formation (3-4 weeks after ingestion)

* Esophagus most prone to perforate during this phase

• As little as 1cc of lye can produce full-thickness necrosis of the esophagus within 30 minutes of ingestion.

• Early changes are better evaluated with endoscopy than contrast studies

• Early treatment may include steroids, antibiotics and, some suggest, prophylactic dilatation. Still as many as 40% will develop strictures.

• There is a significantly higher risk of developing esophageal carcinoma 20-40 years after ingestion.

X-ray

• Mediastinal emphysema

• Left pleural effusion

• Long, smooth strictures

• About 20% have associated gastric abnormality, usually antral narrowing and ulceration

• In the acute phase, a water-soluble esophagram should be performed, followed by barium if no leak is seen.

WH/92