Learning Radiology xray montage

Caustic Esophagitis
Lye Stricture


General Considerations 

  • 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 


  • Mediastinal emphysema
  • Left pleural effusion
  • If a contrast study is done, water-soluble contrast is used in the cute phase
  • Long, smooth esophageal strictures, usually in the distal esophagus
  • 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. 


  • 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.
  • Esophageal perforations may occur

Caustic Esophagitis 

Caustic Esophagitis. Image from a single-contrast barium swallow performed several years after the accidental ingestion of lye demonstrates a long, smooth distal esophageal stricture as evidenced by lack of normal distension of the esophagus.