Management of esophageal caustic injury.

Mark Anthony A De Lusong, Aeden Bernice G Timbol, Danny Joseph S Tuazon
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引用次数: 76

Abstract

Ingestion of caustic substances and its long-term effect on the gastrointestinal system maintain its place as an important public health issue in spite of the multiple efforts to educate the public and contain its growing number. This is due to the ready availability of caustic agents and the loose regulatory control on its production. Substances with extremes of pH are very corrosive and can create severe injury in the upper gastrointestinal tract. The severity of injury depends on several aspects: Concentration of the substance, amount ingested, length of time of tissue contact, and pH of the agent. Solid materials easily adhere to the mouth and pharynx, causing greatest damage to these regions while liquids pass through the mouth and pharynx more quickly consequently producing its maximum damage in the esophagus and stomach. Esophagogastroduodenoscopy is therefore a highly recommended diagnostic tool in the evaluation of caustic injury. It is considered the cornerstone not only in the diagnosis but also in the prognostication and guide to management of caustic ingestions. The degree of esophageal injury at endoscopy is a predictor of systemic complication and death with a 9-fold increase in morbidity and mortality for every increased injury grade. Because of this high rate of complication, prompt evaluation cannot be overemphasized in order to halt development and prevent progression of complications.

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食管腐蚀性损伤的处理。
腐蚀性物质的摄入及其对胃肠道系统的长期影响仍然是一个重要的公共卫生问题,尽管多方努力教育公众并控制其数量的增长。这是由于烧碱剂的现成可用性和对其生产的松散管制。具有极端pH值的物质具有很强的腐蚀性,可以对上胃肠道造成严重伤害。损伤的严重程度取决于几个方面:物质的浓度、摄入的量、与组织接触的时间长短以及药剂的pH值。固体物质很容易粘附在口腔和咽上,对这些区域造成最大的伤害,而液体通过口腔和咽的速度更快,因此对食道和胃的伤害最大。因此,食管胃十二指肠镜检查是一种强烈推荐的评估腐蚀性损伤的诊断工具。它被认为是基石,不仅在诊断,而且在预测和指导管理的腐蚀性摄入。内镜检查时食管损伤程度是全身性并发症和死亡的预测指标,损伤程度每增加一次,发病率和死亡率增加9倍。由于并发症的高发生率,及时评估不能过分强调,以阻止发展和防止并发症的进展。
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