Abstract
Literature on treatment of oesophageal burns by caustic agents includes accidental ingestion in children and attempted suicide in adults but some controversy remains about the use of corticoids. Successful treatment with high doses of steroids has been experimented in cats (1), preventing development of oesophageal strictures. Good results were obtained with an indwelling large naso-gastric tube without steroid treatment (2). Among a series of over 200 children who accidentally ingested caustic products, 15 presented uith grade III oesophagitis at first endoscopy, following ingestion of strong alcali or acid. In the first 7 cases numerous dilatations were needed for treatment of narrow strictures. In 4 further cases the use of a large silastic naso-gastric tube reduced the number of dilatations needed. In 4 last cases the use of large doses of dexamethasone during 3 to 6 weeKs either prevented the development of oesophageal strictures (2 cases) or improved the outcome of the disease (2 cases). Furthermore, this treatment uas also effective in stabilizing the caliber of the oesophagus when used immediately after a dilatation in 4 cases of long-standing stenosis. Good functional results were confimed by 81m-Kr scintiscanning oesophageal transit-time.
Conclusion: in our experience dexamethasone seems to be effective in the treatment of severe oesophageal burns by caustics. Discrepancies with other series might be due to 1) the very large doses we used and 2) smaller amounts of caustics ingested accidentally by children.
(1) A. Haller Pediatrics 34:236, 1964
(2) M.M.BeuKers et al. Annals of ORL 94:337, 1985
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Cadranel, S., Rodesch, P. & Hay, H. LARGE DOSES OF DEXAMETHASONE FOR PREVENTION AND TRATMENT OF NARROW STRICTURES IN CAUSTIC DESOPHAGITIS. Pediatr Res 20, 700 (1986). https://doi.org/10.1203/00006450-198607000-00089
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DOI: https://doi.org/10.1203/00006450-198607000-00089