Caustic ingestion in children: is endoscopy always indicated? The results of an Italian multicenter observational study

Pietro Betalli, Diego Falchetti, Stefano Giuliani, Alessandro Pane, Luigi Dall'Oglio, Gian Luigi de' Angelis, Mariano Caldore, Claudio Romano, Piergiorgio Gamba, Vincenzo Baldo

Research output: Contribution to journalArticle

74 Citations (Scopus)

Abstract

Background: The ingestion of caustic substances can represent a serious medical problem in children. Objective: Whether or not an urgent endoscopy should be performed is still a matter of debate, particularly in asymptomatic patients. Design: We conducted a multicenter observational study to investigate the predictive value of signs and symptoms in detecting severe esophageal lesions. Setting and Patients: The records of 162 children who presented with accidental caustic substance ingestion were analyzed. Interventions: Signs and symptoms were divided into minor (oral and/or oropharyngeal lesions and vomiting) and major (dyspnea, dysphagia, drooling, and hematemesis). An endoscopy was performed in all patients within 12 to 24 hours of the substance being ingested. Main Outcome Measurements: The types of substance ingested, signs and symptoms, age, sex, and severity of esophageal injury were correlated. Results: Mild esophageal lesions were identified in 143 of 162 patients (88.3%), and severe (third degree) esophageal lesions in 19 patients (11.7%). The risk of severe esophageal lesions without signs and/or symptoms was very low (odds ratio [OR] 0.13 [95% CI, 0.02-0.62], P = .002). Indeed, the presence of 3 or more symptoms is an important predictor of severe esophageal lesions (OR 11.97 [95% CI, 3.49-42.04], P = .0001). Multivariate analysis showed that the presence of symptoms is the most significant predictor of severe esophageal lesions (OR 2.3 [95% CI, 1.57-3.38], P = .001). Conclusions: The results demonstrated that the incidence of patients with third-degree lesions without any early symptoms and/or signs is very low, and an endoscopy could be avoided. The risk of severe damage increases proportionally with the number of signs and symptoms, and an endoscopy is always mandatory in symptomatic patients.

Original languageEnglish
Pages (from-to)434-439
Number of pages6
JournalGastrointestinal Endoscopy
Volume68
Issue number3
DOIs
Publication statusPublished - Sep 2008

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Caustics
Endoscopy
Multicenter Studies
Observational Studies
Signs and Symptoms
Eating
Odds Ratio
Sialorrhea
Hematemesis
Deglutition Disorders
Dyspnea
Vomiting
Multivariate Analysis
Incidence
Wounds and Injuries

ASJC Scopus subject areas

  • Gastroenterology

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Caustic ingestion in children : is endoscopy always indicated? The results of an Italian multicenter observational study. / Betalli, Pietro; Falchetti, Diego; Giuliani, Stefano; Pane, Alessandro; Dall'Oglio, Luigi; de' Angelis, Gian Luigi; Caldore, Mariano; Romano, Claudio; Gamba, Piergiorgio; Baldo, Vincenzo.

In: Gastrointestinal Endoscopy, Vol. 68, No. 3, 09.2008, p. 434-439.

Research output: Contribution to journalArticle

Betalli, P, Falchetti, D, Giuliani, S, Pane, A, Dall'Oglio, L, de' Angelis, GL, Caldore, M, Romano, C, Gamba, P & Baldo, V 2008, 'Caustic ingestion in children: is endoscopy always indicated? The results of an Italian multicenter observational study', Gastrointestinal Endoscopy, vol. 68, no. 3, pp. 434-439. https://doi.org/10.1016/j.gie.2008.02.016
Betalli, Pietro ; Falchetti, Diego ; Giuliani, Stefano ; Pane, Alessandro ; Dall'Oglio, Luigi ; de' Angelis, Gian Luigi ; Caldore, Mariano ; Romano, Claudio ; Gamba, Piergiorgio ; Baldo, Vincenzo. / Caustic ingestion in children : is endoscopy always indicated? The results of an Italian multicenter observational study. In: Gastrointestinal Endoscopy. 2008 ; Vol. 68, No. 3. pp. 434-439.
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AU - Pane, Alessandro

AU - Dall'Oglio, Luigi

AU - de' Angelis, Gian Luigi

AU - Caldore, Mariano

AU - Romano, Claudio

AU - Gamba, Piergiorgio

AU - Baldo, Vincenzo

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