Caustic Esophageal Injuries in Children: Current Approaches to Diagnosis and Management

Background: Caustic esophageal injuries in children remain a significant global health concern, typically resulting from the accidental ingestion of household cleaning agents, such as drain cleaners or disc batteries. These injuries range from mild mucosal inflammation to severe transmural necrosis, often leading to lifelong complications. Objective: This review explores the current diagnostic and therapeutic strategies aimed at minimizing morbidity and improving long-term outcomes in pediatric populations. Diagnosis: Early assessment is critical. While clinical symptoms (e.g., drooling, vomiting, or stridor) are common, they often correlate poorly with the severity of internal damage. Flexible esophagogastroduodenoscopy (EGD) remains the gold standard for grading injury severity and should ideally be performed within 12 to 24 hours post-ingestion. Recent advancements in imaging, such as Computed Tomography (CT), are increasingly used to evaluate transmural involvement and the risk of perforation. Management: Treatment protocols are stratified based on endoscopic grading. Grade I and IIa injuries generally require supportive care and brief observation. Conversely, Grade IIb and III injuries necessitate aggressive management, including intravenous fluids, nutritional support (often via enteral routes), and the controversial use of corticosteroids to prevent stricture formation. In cases of acute perforation, emergent surgical intervention is mandatory. Long-term Considerations: The most frequent chronic complication is esophageal stricture, which often requires repeated endoscopic dilatations. Furthermore, children with severe caustic injuries face a significantly elevated long-term risk of esophageal carcinoma, necessitating lifelong surveillance. Conclusion: A multidisciplinary approach involving pediatric gastroenterologists, surgeons, and nutritionists is essential. Future efforts should focus on standardized global protocols and stricter public health regulations regarding the packaging and acidity/alkalinity of household chemicals.

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