Combined use of steroid, antibiotics and early bougienage against stricture formation following caustic esophageal burns

Background. If an esophageal burn is diagnosed, the aim is to prevent struc ture formation. The combined use of steroid, antibiotics and early bougiena ge (SAEB) is one of the currently used treatment protocols. The effect of S AEB treatment against structure formation following caustic esophageal burn has been evaluated retrospectively. Methods. Forty-nine children of 282 admitted with a history of caustic subs tance ingestion were found to have esophageal burns. Forty-nine children un derwent treatment against structure formation. SAFE was begun within 48 hou rs of ingestion. Results. Eight children of 12 who ingested sodium hydroxide and five childr en of 20 who ingested acids developed strictures in spite of the therapy. A dditionally two esophageal perforations were encountered in patients who in gested sodium hydroxide. Conclusions. This protocol has been found to carry a risk of perforation wi thout preventing structure formation after strong alkali ingestion. Therefo re other treatment modalities for preventing strictures should be evaluated especially in children who have ingested products containing strong alkali s.