Review
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World J Gastroenterol. Jul 7, 2013; 19(25): 3918-3930
Published online Jul 7, 2013. doi: 10.3748/wjg.v19.i25.3918
Caustic injury of the upper gastrointestinal tract: A comprehensive review
Sandro Contini, Carmelo Scarpignato
Sandro Contini, Department of Surgical Sciences, University of Parma, 43125 Parma, Italy
Carmelo Scarpignato, Clinical Pharmacology and Digestive Pathophysiology Unit, Department of Clinical and Experimental Medicine, University of Parma, 43125 Parma, Italy
Author contributions: Both authors substantially contributed to the article and approved the final version to be published.
Correspondence to: Sandro Contini, MD, Former Professor of Surgery, Department of Surgical Sciences, University of Parma, Strada S. Eurosia 45/B, 43125 Parma, Italy. sandrocontini46@gmail.com
Telephone: +39-348-5656989 Fax: +39-348-5656989
Received: February 4, 2013
Revised: March 24, 2013
Accepted: April 27, 2013
Published online: July 7, 2013
Processing time: 152 Days and 3.4 Hours
Abstract

Prevention has a paramount role in reducing the incidence of corrosive ingestion especially in children, yet this goal is far from being reached in developing countries, where such injuries are largely unreported and their true prevalence simply cannot be extrapolated from random articles or personal experience. The specific pathophysiologic mechanisms are becoming better understood and may have a role in the future management and prevention of long-term consequences, such as esophageal strictures. Whereas the mainstay of diagnosis is considered upper gastrointestinal endoscopy, computed tomography and ultrasound are gaining a more significant role, especially in addressing the need for emergency surgery, whose morbidity and mortality remains high even in the best hands. The need to perform emergency surgery has a persistent long-term negative impact both on survival and functional outcome. Medical or endoscopic prevention of stricture is debatable, yet esophageal stents, absorbable or not, show promising data. Dilatation is the first therapeutic option for strictures and bougies should be considered especially for long, multiple and tortuous narrowing. It is crucial to avoid malnutrition, especially in developing countries where management strategies are influenced by malnutrition and poor clinical conditions. Late reconstructive surgery, mainly using colon transposition, offers the best results in referral centers, either in children or adults, but such a difficult surgical procedure is often unavailable in developing countries. Possible late development of esophageal cancer, though probably overemphasized, entails careful and long-term endoscopic screening.

Keywords: Caustic ingestion; Corrosive stricture; Developing countries; Surgical management; Endoscopic management

Core tip: The incidence of corrosive ingestion is high and largely unreported in developing countries, where prevention is lacking. Computed tomography and endoscopic ultrasound are gaining a more meaningful role in addressing the need for emergency surgery. The need to perform emergency surgery has a persistent long-term negative impact both on survival and functional outcome. Prevention of stricture is still a debatable issue, yet esophageal stents may offer promising outcomes. It is crucial to avoid malnutrition, especially in developing countries where management strategies are conditioned by poor clinical conditions. Late reconstructive surgery is often unavailable in developing countries.