THERAPEUTIC EFFECTS OF WATER AND MILK FOR ACUTE ALKALI INJURY OF THE ESOPHAGUS

Study background: Alkali ingestions cause progressive and devastating injury to the esophagus by liquefaction necrosis. However, the therape utic efficacy of water or milk dilution for alkali-induced esophageal injury has not been determined. This study used our previously reporte d model of alkali-induced esophageal injury to evaluate the effectiven ess of water and milk dilution. Hypothesis: Early dilution with water or milk is efficacious in decreasing esophageal damage from alkali exp osure. Methods: The esopgagi of 75 Sprague-Dawley rats were harvested, and each end was cannulated with a 20-gauge catheter. Specimens were maintained in an oxygenated saline solution (at 37-degrees-C) during a 60-minute experimental period and then fixed immediately in 10% Forma lin solution for histologic examination. Esophagi from six experimenta l groups (total of 60) were perfused with 50% NaOH solution at time 0. Water or milk dilution was performed immediately at 0 minutes, 5 minu tes after injury, and 30 minutes after injury. Blinded pathologic exam ination was performed using a score of 0 (no injury), 1 (minimal), 2 ( moderate), or 3 (severe) for the following six histologic categories: epithelial viability, cornified epithelial cell differentiation, granu lar cell differentiation, epithelial cell nuclei, muscle cells, and mu scle cell nuclei. Results: Positive and negative controls showed expec ted outcomes. Significant progressions of injury over time were seen f or every histologic category for both water and milk dilution. The inj ury scores for the milk-treated group at 0 minutes were less than or e qual to the injury score for the water-treated group for all categorie s. However, these differences were significant only for the cornified epithelial cells. Conclusion: Early dilution therapy with water or mil k reduces acute alkali injury of the esophagus and supports use of the se forms of emergency treatment.