O. Mutaf et al., GASTROESOPHAGEAL REFLUX - A DETERMINANT IN THE OUTCOME OF CAUSTIC ESOPHAGEAL BURNS, Journal of pediatric surgery, 31(11), 1996, pp. 1494-1495
Deep circumferencial burns of the esophagus always result in stricture
formation and obstruction of the lumen. The usual treatment of causti
c esophageal strictures is long-term esophageal dilatations. A new met
hod of treatment, long-term stenting of the strictured esophagus gave
superior results when compared with the classic dilatation therapy (he
ating rates, 68% v 33%; P < .01). Although success in the stent group
was very satisfactory, the 32% failure rate requires explanation. In t
he years between 1991 and 1993, 53 stent-treated patients were screene
d for gastroesophageal reflux (GER). All patients were investigated wi
th 24-hour ambulatory distal esophageal pHmetry. In 18 patients reflux
index (RI) was found to be below 4. In 14 patients RI was between 4.1
and 19. In the final group of 21 patients RI was over 20 (minimum, 21
.8; maximum, 72.8). When these data were compared with the healing rat
es of the patients, it was found that none of the 21 patients with RI
over 20 responded to the described therapy. We conclude that the esoph
agus, after a serious caustic insult, not only narrows but also shorte
ns thus altering the lower esophageal sphincter function leading to se
rious GER. Therefore all caustic esophageal burn patients should be sc
reened for GER periodically during the dilatation or stent therapy pro
grams, and GER should be controlled before RI approaches 20. Copyright
(C) 1996 by W.B. Saunders Company.