SEVERITY OF CAUSTIC SUBSTANCES INGESTION IN CHILDREN

Background. - Caustic ingestion is frequent in children, sometimes lea ding to esophageal stricture. Patients and methods. - Between 1988 and 1994, esogastroscopy was performed in 65 children after caustic inges tion. The children were classified in three groups: no lesion (group A ), minimal lesions (group B) and severe lesions (group C). Nature of t he caustic substance, clinical signs and evolution were compared in th e three groups. Results. - Median age was 2 years for the 65 children (24 girls, 41 boys). Ingestion occurred at home (94%) during meal peri ods. Substances were dishwater detergents (n = 14), oven cleaner (n = 10), bleach (n = 9), washing powder (n = 4), others (n = 20) or abdomi nal pain (n = 10) not correlated to endoscopic findings, and hematemes is (n = 3) or respiratory distress (n = 4), both symptoms seen only in group C. Buccal lesions (41%) were not correlated to endoscopic findi ngs. After endoscopy, 28 children (43%) were classified into group A a nd 20 children (31%) in group B. Among the 17 children (26%) of the gr oup C, eight developed an esophageal stricture: seven long strictures requiring replacement of the esophagus, one short stricture requiring repeated dilations. Conclusion. - Esophageal stricture is still a seve re complication after caustic ingestion. These data stress the interes t of controlled studies to confirm the preventive role of high dose co rticosteroids, and the importance of the preventin of accidential caus tic ingestions in children.