Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 15-18: Caustic Esophageal Injury + Key Features Download Section PDF Listen +++ ++ Follows accidental or deliberate (suicidal) ingestion of alkali (drain cleaners, etc) or acid + Clinical Findings Download Section PDF Listen +++ ++ Severe burning and chest pain, gagging, dysphagia, and drooling Aspiration results in stridor and wheezing + Diagnosis Download Section PDF Listen +++ ++ Assess circulatory status Assess airway patency and oropharyngeal mucosa, including laryngoscopy Obtain chest and abdominal radiographs to look for pneumonitis, perforation Endoscopy + Treatment Download Section PDF Listen +++ ++ Supportive treatment, intravenous fluids, analgesics Intravenous proton pump inhibitors to prevent gastric stress ulceration (pantoprazole or esomeprazole, 40 mg twice daily) Nasogastric lavage and oral antidotes should not be administered Laryngoscopy should be performed in patients with respiratory distress to assess the need for tracheostomy Endoscopy within the first 12–24 hours to assess extent and severity of mucosal damage Patients with mild damage (edema, erythema, exudates, or superficial ulcers) Recover quickly Have low risk of stricture May be advanced from liquids to regular diet over 24–48 hours Patients with severe injury (deep or circumferential ulcers or necrosis) Have a high risk (up to 65%) of acute perforation with mediastinitis or peritonitis, bleeding, stricture, or esophageal-tracheal fistulas Must be kept fasting and monitored closely for signs of deterioration that warrant emergency surgery Surgery: esophagectomy and colonic or jejunal interposition, nasoenteric feeding tube Neither corticosteroids nor antibiotics are recommended Strictures develop in up to 70% of patients with serious esophageal injury weeks to months after initial injury, requiring recurrent dilations Endoscopic injection of intralesional corticosteroids (triamcinolone 40 mg) increases the interval between dilations Esophageal squamous carcinoma occurs in 2–3%, warranting endoscopic surveillance 15–20 years after the caustic ingestion