Mucosal Injury after Caustic Ingestion 4 VOL. 47 NO. 2 2013 ACTA MEDICA PHILIPPINA _______________ Corresponding author: Germana V. Gregorio, MD Section of Pediatric Gastroenterology, Hepatology and Nutrition Department of Pediatrics Philippine General Hospital University of the Philippines Manila Taft Avenue, Ermita, Manila 1000 Philippines Telephone: +632 5269167 Fax No: +632 5260150 Email: germana1@hotmail.com Factors Associated with Severe Mucosal Injury of Esophagogastroduodenoscopy after Caustic Substance Ingestion in Pediatrics Ma. Charina Batac-Dizon, 1 Cynthia P. Cordero 2 and Germana V. Gregorio 1 1 Section of Pediatric Gastroenterology, Hepatology and Nutrition. Department of Pediatrics, College of Medicine and Philippine General Hospital, University of the Philippines Manila 2 Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila Introduction Caustic substance ingestion is a common major health hazard in the pediatric age group. The resultant injury to the upper gastrointestinal tract mucosa may be insignificant but in some cases may lead to strictures or perforations. An esophagogastroduodenoscopy (EGD), which is the exploration of the proximal gastrointestinal tract, 1 is considered the most effective way in assessing the integrity of the mucosal damage after ingestion. However, published studies are contradictory and inconclusive as to whether routine EGD should be done in all patients with caustic substance ingestion as severe mucosal injury is only seen in <30% of cases. Gaudreault 2 concluded that signs and symptoms do not predict the presence and or the severity of esophageal damage and suggested that routine EGD be done in all patients. On the other hand, Crain 3 and Betalli 4 reported that the presence of two or more signs (vomiting, drooling, stridor) is a good predictor of esophageal injury. Other studies, all done in developed countries, have suggested that EGD is not indicated in asymptomatic patients with a recent history of accidental, but not for intentional ingestion. 5,6,7 The present practice of the Section of Pediatric Gastroenterology of the University of the Philippines Manila–Philippine General Hospital is to do routine endoscopy on all cases of caustic ingestion regardless of symptoms. This is the recommendation of the Toxicology service of the hospital based on the premise that even in the absence of signs and symptoms, other factors like age of the patient, type of solution and nature of ingestion (whether accidental or intentional) play a role in mucosal injury. Silver jewelry cleaner, a substance with cyanide as the active component, and a pH of 9-10 had also been demonstrated as a common caustic substance in our setting, but the exact mucosal damage caused by this solution remains unclear. However, it has been our experience that the majority of children with caustic ingestion only have normal or minimal lesions, especially if they are asymptomatic and the exposure is accidental. In 2004, an unpublished review of 52 Filipino children with caustic ingestion at the Philippine General Hospital identified sodium hypochlorite (a household bleaching agent) as the most common agent. Thirteen percent (13%) of patients had severe mucosal injury and all of these patients were symptomatic. The study further reported that the probability of having severe mucosal injury was increased by six-fold in the presence of two or more symptoms. However, the sample size limited the conclusions and recommendations of the study. This study ORIGINAL ARTICLE