Key Points
- Use the highest‑yield diagnostic test early; do not let testing delay time‑critical therapy.
- Set objective targets and reassess frequently.
- Plan definitive source control or disease‑specific therapy when indicated; document follow‑up and patient education.
Algorithm
- Airway assessment and resuscitation; keep strict NPO; avoid neutralization/emesis.
- Obtain early endoscopy (12–24 h) unless perforation suspected; use CT to assess complications.
- Manage based on grade: minor → advance diet; high‑grade → ICU, antibiotics, PPI, surgical consult; plan nutrition (NJT/TPN).
- Long‑term: stricture surveillance/dilation; psychosocial evaluation if intentional.
Clinical Synopsis & Reasoning
Accidental or intentional ingestion of acids/alkalis causes esophageal/gastric injury. Keep NPO, avoid neutralizing/emesis/NG placement blindly, and perform early endoscopy (within 12–24 h) to grade injury; manage severe injuries in ICU with perforation surveillance and staged nutrition.
Treatment Strategy & Disposition
Stabilize ABCs. Initiate guideline‑concordant first‑line therapy with precise dosing and continuous monitoring. Escalate to advanced/procedural interventions based on explicit failure criteria. Define ICU, step‑down, and ward disposition triggers; involve specialty teams early.
Epidemiology / Risk Factors
- Risk varies by comorbidity and precipitants; see citations for condition‑specific data.
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| Endoscopy within 12–24 h | Severity grading | Zargar grade | Avoid if perforation suspected |
| CT chest/abdomen with IV contrast | Complications | Perforation/necrosis | Adjunct to endoscopy |
| Labs including lactate | Severity | Systemic toxicity | Guide resuscitation |
Pharmacology
| Medication/Intervention | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| IV PPI | Acid suppression | Hours | Mucosal protection | — |
| Broad antibiotics (selected severe) | Infection prevention | Hours | If high‑grade injury or perforation | Practice varies |
| Steroids (controversial; selected) | Anti‑inflammatory | Days | May reduce strictures in select grade II injuries | Not with perforation/infection |
Prognosis / Complications
- Outcome depends on timeliness of diagnosis and definitive therapy; monitor for complications.
Patient Education / Counseling
- Provide red‑flag education, adherence guidance, and explicit return precautions; arrange timely specialty follow‑up.
References
- WSES/ESGE statements on caustic ingestion management — Link