HISTOPATHOLOGIC EVALUATION OF THE THERAPEUTIC EFFICACY OF WATER AND MILK DILUTION FOR ESOPHAGEAL ACID INJURY

Objective: To determine whether acid-induced injury to the esophagus i s decreased by early dilutional therapy with water or milk. Methods: A controlled in-vitro animal model for acid injury to the esophagus was carried out using esophagi harvested from 70 Sprague-Dawley rats of b oth sexes and weighing 250-350 g. One control and six experimental gro ups each containing ten esophagi were instilled with 1 mL of 0.5 norma l solution of hydrogen chloride (N HCl). dilution with water or milk w as performed at 0, 5, or 30 minutes postinjury in the experimental gro ups. No dilution was performed with the control group. Specimens were maintained in an oxygenated saline bath for a 60-minute experimental p eriod and then fixed in 10% formalin for histologic evaluation. Injury severity was rated by blinded histopathologic examination using score s of 0 (no injury) 1 (minor), 2 (moderate), and 3 (severe) for the his topathologic categories: cornified epithelial cells (CEs), granular ce lls (GCs), granular cell nuclei (GNs), and basal cells (BCs). Red bloo d cells were scored as positive or negative for lysis. Results: The co ntrols showed the most severe outcomes. Significant differences in inj ury occurred for all time periods and histopathologic categorise, exce pt for the GN/water and BC/milk histopathologic category/treatment gro ups. However, a linear trend analysis was significant for all histopat hologic categories except BC. These analyses support decreased injury in the earlier treated groups. Injury severity was highest in the most superficial cell layer (CE). Conclusions: Emergency therapy with wate r or milk reduces acute acid injury to the esophagus. Earlier treatmen t is associated with decreased injury severity. This research supports the use of dilutional therapy with water or milk for acute acid injur y to the esophagus.