EFFECTS OF PREDNISOLONE AND DEXAMETHASONE IN CHILDREN WITH ALKALI BURNS OF THE ESOPHAGUS

We compared the efficacies of prednisolone and dexamethasone for treat ment of children with oesophageal bums due to ingestion of caustic sub stances. The criteria of efficacy used were a) stricture severity by 3 weeks post-ingestion, b) reduction in burn severity by 3 weeks post-i ngestion and c) number of dilatations required over the first year pos t-ingestion. Thirty-six children (24 boys and 12 girls; mean age 23.6 +/- 7.4 months) were selected from a total of 63 patients admitted ove r a ten-year period to the General Hospital of Galicia with second- or third-degree oesophageal bums due to accidental ingestion of liquid a lkali preparations. The patients were divided into two groups of 18, o ne group for treatment with prednisolone (2 mg/kg/day) and the other f or treatment with dexamethasone (1 mg/kg/day). Strictures developed in 12 (66.7%) of the children in the prednisolone-treated group and only 7 (38.9%) of the children in the dexamethasone-treated group. Severe strictures developed in 10 (55.6%) of the children in the prednisolone -treated group and only 5 (27.8%) of the children in the dexamethasone -treated group. However there was no significant difference between th e groups in the post-treatment distribution of stricture-severity rati ngs. Burn healing was significantly better in the dexamethasone-treate d group. Similarly, the number of dilatations necessary during the fir st year of treatment was significantly lower in the dexamethasone-trea ted group. Our results thus indicate that, by comparison with predniso lone, dexamethasone leads to improved burn healing and reduced need fo r dilatations during the first year post-injury.