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Razinger G, Rotovnik Kozjek N. The Impact of Caustic Ingestion on Nutritional Status: Case Report. Case Rep Gastroenterol 2024; 18:195-203. [PMID: 38585022 PMCID: PMC10997316 DOI: 10.1159/000537796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/10/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Caustic injuries remain a major public health concern. Nutritional status plays a pivotal role in determining the outcome. Unfortunately, nutritional care guidelines are not widely implemented in clinical practice, and decisions are often based on prior experience and local policies. Case Presentation We present the case of an 83-year-old man who accidentally ingested alkali, resulting in severe caustic injury and subsequent complications that further deteriorated his nutritional status. The management of esophageal strictures necessitated constant adjustments to the nutritional strategies employed. The clinical evaluation revealed protein and energy malnutrition, accompanied by type 2 intestinal failure. However, with individually tailored parenteral nutritional therapy, a significant improvement in the patient's nutritional status was observed. Conclusion Recognizing that caustic injuries increase metabolic demands, a comprehensive and active nutritional assessment is crucial, focusing on the need for adequate energy, high protein intake, and an appropriate feeding route. In cases of acute or prolonged type 2 intestinal failure with insufficient oral or enteral nutrition, parenteral feeding should be the primary therapy. Effective management of caustic injuries requires a multidisciplinary and multicenter approach, integrating nutritional evaluation, including body composition measurements, into the clinical algorithm. Early initiation of nutritional therapy is vital to prevent chronic intestinal failure.
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Affiliation(s)
- Gašper Razinger
- Center for Clinical Toxicology and Pharmacology, University Medical Center Ljubljana, Ljubljana, Slovenia
- University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - Nada Rotovnik Kozjek
- University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
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Sabrine BY, Messaoud M, Samia B, Meriem BF, Radhouane BS, Maha BM, Sawsen C, Sami S, Sana M, Amine K, Amel G, Imen Z, Lassaad S, Mongi M, Mohsen B. Outcomes of pneumatic dilation in pediatric caustic esophageal strictures: a descriptive and analytic study from a developing country. Surg Endosc 2023; 37:9291-9298. [PMID: 37884732 DOI: 10.1007/s00464-023-10489-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/23/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVES Corrosive substance ingestion in children represents a significant public health issue due to its long-term health sequelae. Esophageal stricture, main complication of this dangerous condition, is treated by pneumatic dilation and eventually by esophageal replacement. We aimed, through this study, to report the outcomes of esophageal pneumatic dilation complicating corrosive substance ingestion in children in a developing country. METHODS This cross-sectional study was performed on the population of pediatric patients with caustic esophageal stenosis between January 2005 and December 2020. All patients underwent pneumatic balloon dilation. A logistic regression model was built to predict the probability of the occurrence of the event (success/failure) of the dilation. The ROC curve is used to evaluate the performance of the logistic regression model to discriminate between positive and negative values of the dependent variable. RESULTS The success rate of pneumatic balloon dilation was 80.4%. The median duration of overall management was 11 months. The severity of caustic stricture observed during endoscopy was significantly linked to worse outcomes (p = 0.001). Multivariate analysis indicated that the severity of stenosis and the number of dilation sessions were independent risk factors for failure of dilation. ROC curve analysis showed that the area under the curve was 71.7%. A Cut-Off point value of 7 provided the best sensitivity and specificity. CONCLUSION Pneumatic balloon dilation has been proven to be efficacious in infants with caustic esophageal stricture. Pediatric surgeons should take into account factors to promptly switch to replacement surgery and avoid unnecessary and time-consuming serial dilations.
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Affiliation(s)
- Ben Youssef Sabrine
- Pediatric Surgery Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
- University of Monastir, Faculty of Medicine of Monastir, Monastir, Tunisia.
| | - Marwa Messaoud
- Pediatric Surgery Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- University of Monastir, Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Belhassen Samia
- Pediatric Surgery Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- University of Monastir, Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Ben Fredj Meriem
- Pediatric Surgery Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- University of Monastir, Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Ben Salah Radhouane
- Pediatric Surgery Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- University of Monastir, Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Ben Mansour Maha
- Anesthesiology Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- University of Monastir, Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Chakroun Sawsen
- Anesthesiology Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- University of Monastir, Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Sfar Sami
- Pediatric Surgery Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- University of Monastir, Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Mosbahi Sana
- Pediatric Surgery Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- University of Monastir, Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Ksia Amine
- Pediatric Surgery Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- University of Monastir, Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Gara Amel
- Epidemiology and Preventive Medicine Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- University of Monastir, Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Zemni Imen
- Epidemiology and Preventive Medicine Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- University of Monastir, Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Sahnoun Lassaad
- Pediatric Surgery Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- University of Monastir, Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Mekki Mongi
- Pediatric Surgery Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- University of Monastir, Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Belghith Mohsen
- Pediatric Surgery Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- University of Monastir, Faculty of Medicine of Monastir, Monastir, Tunisia
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Patterson KN, Beyene TJ, Gil LA, Minneci PC, Deans KJ, Halaweish I. Procedural and Surgical Interventions for Esophageal Stricture Secondary to Caustic Ingestion in Children. J Pediatr Surg 2023; 58:1631-1639. [PMID: 36878759 DOI: 10.1016/j.jpedsurg.2023.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/24/2023] [Accepted: 01/30/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Esophageal injury after caustic ingestion can vary in severity and may result in significant long-term morbidity due to stricture development. The optimal management remains unknown. We aim to determine the incidence of esophageal stricture due to caustic ingestion and quantify current procedural and operative management strategies. METHODS The Pediatric Health Information System (PHIS) was utilized to identify patients 0-18 years old who experienced caustic ingestion from January 2007-September 2015 and developed subsequent esophageal stricture until December 2021. Post-injury procedural and operative management was identified utilizing ICD-9/10 procedure codes for esophagogastroduodenoscopy (EGD), esophageal dilation, gastrostomy tube placement, fundoplication, tracheostomy, and major esophageal surgery. RESULTS 1,588 patients from 40 hospitals experienced caustic ingestion of which 56.6% were male, 32.5% non-Hispanic White, and the median age at time of injury was 2.2 years (IQR: 1.4,4.8). Median length of initial admission was 1.0 day (IQR: 1.0, 3.0). 171/1,588 (10.8%) developed esophageal stricture. Among those who developed stricture, 144 (84.2%) underwent at least 1 additional EGD, 138 (80.7%) underwent dilation, 70 (40.9%) underwent gastrostomy tube, 6 (3.5%) underwent fundoplication, 10 (5.8%) underwent tracheostomy, and 40 (23.4%) underwent major esophageal surgery. Patients underwent a median of 9 dilations (IQR 3, 20). Major surgery was performed at a median of 208 (IQR: 74, 480) days after caustic ingestion. CONCLUSION Many patients with esophageal stricture after caustic ingestion will require multiple procedural interventions and potentially major surgery. These patients may benefit from early multi-disciplinary care coordination and the development of a best-practice treatment algorithm. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kelli N Patterson
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Tariku J Beyene
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Lindsay A Gil
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Peter C Minneci
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA; Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Katherine J Deans
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA; Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Ihab Halaweish
- Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
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Angelino G, Tambucci R, Torroni F, De Angelis P, Dall'Oglio L. New therapies for esophageal strictures in children. Curr Opin Pediatr 2021; 33:503-508. [PMID: 34354006 DOI: 10.1097/mop.0000000000001049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The present review aims at describing recent advances in therapeutic strategies for the treatment of benign esophageal strictures in children. We discuss current knowledge and practice on esophageal dilations, which are still the mainstream of treatment. We present new evidence about adjuvant treatments for recurrent and refractory strictures, including endoscopic incisional therapy, esophageal stenting, intralesional or topical mytomicin C and intralesional, systemic or topical steroids. RECENT FINDINGS Current evidence on esophageal dilations is not sufficient to establish superiority of one of the available techniques, especially the use of balloon or bougie dilators, but a prospective international cohort study on anastomotic stricture in esophageal atresia is underway to address this issue. Recurrent and refractory strictures still represent a challenge, since none of the adjuvant pharmacological and mechanical interventions has shown to be enough feasible, effective and safe to revolutionize clinical practice. SUMMARY In the last couple of years, several encouraging results have been published on management of esophageal strictures in children. Further research is needed, hopefully directed toward secure, easily reproducible and minimally invasive measures.
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Affiliation(s)
- Giulia Angelino
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital - Scientific Institute for Research and Healthcare, Rome, Italy
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Thongchuam C, Mahawongkajit P, Kanlerd A. The Effect of the COVID-19 on Corrosive Ingestion in Thailand. Open Access Emerg Med 2021; 13:299-304. [PMID: 34267561 PMCID: PMC8275177 DOI: 10.2147/oaem.s321218] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/22/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose Since January 2020, the outbreak of COVID-19 coronavirus has impacted global mental health, daily activities, and economies, including Thailand. The essential strategy is the disease-preventing measure of “lockdown.” Corrosive ingestion is one of the most common forms of self-harm and problems worldwide. This study aimed to evaluate the effect of corrosive ingestion in the COVID-19 situation. Methods This was a retrospective study of adult patients (≥18y) who had ingested corrosives and been admitted to surgical department, Thammasat University Hospital between June and December 2019 (pre-COVID-19) and January to June 2020 (COVID-19 period) and compared the epidemiological and clinical features between these two groups. Results Nine and 20 patients were admitted in the pre-COVID-19 and COVID-19 periods, for an increase of 122%; males numbered 15. A minority of ingestions, 8/29, were intentional of which 7 were in the COVID-19 period. The Zargar classification showed a trend towards more gastric injury in the COVID-19 vs pre-COVID-19 periods: 8/17 vs 1/9 (p=0.09). Because of the endoscopic grade 0 in stomach was significantly higher in pre-COVID-19 than COVID-19 case (pre-COVID-19; 8 patients (88.9%), COVID-19; 9 patients (45%); p value 0.011). Conclusion Data from this study suggest increasing trends of corrosive ingestion and greater gastric injury during the COVID-19 period.
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Affiliation(s)
- Chatbadin Thongchuam
- Department of Surgery, Faculty of Medicine, Thammasat University, Amphur Klongluang, Pathumthani, 12120, Thailand
| | - Prasit Mahawongkajit
- Department of Surgery, Faculty of Medicine, Thammasat University, Amphur Klongluang, Pathumthani, 12120, Thailand
| | - Amonpon Kanlerd
- Department of Surgery, Faculty of Medicine, Thammasat University, Amphur Klongluang, Pathumthani, 12120, Thailand
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Limdi JK. Editorial commentary on the Indian Journal of Gastroenterology- May-June 2021. Indian J Gastroenterol 2021; 40:249-252. [PMID: 34009562 PMCID: PMC8132035 DOI: 10.1007/s12664-021-01188-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Jimmy K Limdi
- Section of Inflammatory Bowel Diseases, Division of Gastroenterology, The Pennine Acute Hospitals NHS Trust, Manchester, UK.
- Manchester Academic Health Sciences, University of Manchester, Manchester, UK.
- Manchester Metropolitan University, Manchester, UK.
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