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Chemical esophagitis — Clinical Guidelines

Overview

Chemical esophagitis results from the corrosive effects of caustic substances ingested or aspirated into the esophagus, leading to mucosal injury and potential severe complications. 14

Diagnosis

Clinical history of ingestion or aspiration of caustic substances.

Endoscopic findings showing esophageal mucosal injury patterns (e.g., erythema, ulceration, strictures).

Radiographic imaging may reveal esophageal narrowing or air-fluid levels indicative of esophageal injury. 14

Management

Initial Management: Immediate irrigation with large volumes of saline to dilute and wash out the caustic agent 14.

Supportive Care: Maintenance of airway patency, fluid resuscitation, and monitoring for respiratory distress or airway compromise.

Surgical Intervention: Indicated for cases with perforation, significant mediastinitis, or persistent strictures unresponsive to medical management 14.

Monitoring: Regular endoscopic evaluations to assess healing and detect complications such as strictures or Barrett's esophagus 14.

Special Populations

Pediatrics: Children may present with atypical symptoms; careful monitoring for delayed complications is crucial 14.

Elderly: Increased risk of complications due to comorbid conditions and potentially slower healing; close follow-up is essential 14.

Key Recommendations

Prompt irrigation with saline to mitigate tissue damage upon suspicion of chemical esophagitis (Evidence: Expert opinion) 14

Regular endoscopic surveillance is necessary to manage complications and ensure proper healing (Evidence: Expert opinion) 14

Early identification and management of airway compromise are critical in all age groups (Evidence: Expert opinion) 14

References

1 Gan RK, Bruni E, Castro Delgado R, Alsua C, Arcos González P. Novel Google Maps and Google Earth application for chemical industry disaster risk assessment during complex emergencies in Eastern Ukraine. Scientific reports 2023. link 2 Seaton MG, Maier A, Sachdeva S, Barton C, Ngai E, Lentz TJ et al.. A framework for integrating information resources for chemical emergency management and response. American journal of disaster medicine 2019. link 3 Seaton MG, Maier A, Sachdeva S, Barton C, Ngai E, Lentz TJ et al.. A framework for integrating information resources for chemical emergency management and response. Journal of emergency management (Weston, Mass.) 2019. link 4 Koh DH, Lee SG, Kim HC. Incidence and characteristics of chemical burns. Burns : journal of the International Society for Burn Injuries 2017. link 5 Ye C, Wang X, Zhang Y, Ni L, Jiang R, Liu L et al.. Ten-year epidemiology of chemical burns in western Zhejiang Province, China. Burns : journal of the International Society for Burn Injuries 2016. link 6 . Notes from the field: Exposures to discarded sulfur mustard munitions - Mid-Atlantic and New England States 2004-2012. MMWR. Morbidity and mortality weekly report 2013. link 7 Karydes HC, Zautcke JL, Zell-Kanter M. Chemical and traumatic occupational eye exposures in aviation personnel. Aviation, space, and environmental medicine 2011. link 8 Kintz P, Villain M, Dumestre V, Cirimele V. Evidence of addiction by anesthesiologists as documented by hair analysis. Forensic science international 2005. link 9 Sheridan RL, Ryan CM, Quinby WC, Blair J, Tompkins RG, Burke JF. Emergency management of major hydrofluoric acid exposures. Burns : journal of the International Society for Burn Injuries 1995. link90785-x) 10 Weeks AM, Buckland MR, Morgan EB, Myles PS. Chemical dependence in anaesthetic registrars in Australia and New Zealand. Anaesthesia and intensive care 1993. link 11 Steffen PD, Dailey RH. Appropriate management of chemical dependency in emergency medicine residents. Annals of emergency medicine 1992. link82525-9) 12 Borak J, Sidell FR. Agents of chemical warfare: sulfur mustard. Annals of emergency medicine 1992. link80892-3) 13 Talbott GD, Gallegos KV, Wilson PO, Porter TL. The Medical Association of Georgia's Impaired Physicians Program. Review of the first 1000 physicians: analysis of specialty. JAMA 1987. link 14 Milner JE. The office treatment of minor chemical skin burns. Cutis 1982. link

Chemical esophagitis