OVERVIEW
Corrosive esophagitis mainly includes chemical burns as well as esophagitis caused by certain drugs, and the most common clinical condition is esophageal chemical burns. Chemical burns of the esophagus can be caused by accidental ingestion of certain chemicals, which are clinically categorized into acidic and alkaline chemical burns. In addition to the nature of the corrosive agent, the degree of injury also depends on the concentration of the corrosive agent, the dosage and the length of contact time and other factors. Esophageal chemical burn is a kind of thoracic surgery emergency, improper treatment may cause serious complications, resulting in disability or death of the patient.
Etiology
The disease can occur in all age groups, children are mostly self-administered or mistakenly administered by adults, adults are mostly caused by suicide.
Symptoms
Symptoms vary depending on the type and amount of chemical corrosive ingested. Generally speaking, the early symptoms are salivation, vomiting, fever, pain and difficulty in swallowing, retrosternal and subxiphoid pain, which gradually disappears in about 2 weeks. In the late stage of burns (about 1 month later), dysphagia reappears and tends to worsen gradually, and partial or complete oesophageal obstruction occurs. Cough, shortness of breath and respiratory aspiration human pulmonary edema or infection can be complicated.
Examination
Laboratory tests are of no particular value in chemical burns of the esophagus and may show hydroelectrolyte disturbances due to dehydration, violent vomiting, etc.
A chest radiograph may show lung damage and the presence of mediastinitis. In the acute stage, barium meal examination of upper gastrointestinal tract is generally not recommended to avoid esophageal and gastric perforation. After the acute stage, barium meal examination can be performed to find out whether there is coarseness of the mucosa of the sinus, whether there is deformation of the gastric lumen, whether there is narrowing of the esophagus, and the degree of gastric sinus stenosis or pyloric obstruction. In the late stage, if the patient can only swallow fluids, iodized water can be swallowed for contrast examination.
Gastroscopy is absolutely contraindicated in the early stage; in the late stage, if the patient can eat liquid or semi-liquid, gastroscopy can be done cautiously to find out whether there is any stenosis or obstruction of the esophagus and gastric sinus or pylorus. If the esophagus is highly narrowed and the gastroscope cannot pass through, it should not be rigidly inserted to avoid perforation.
Diagnosis
Diagnosis relies mainly on medical history. Pharyngeal burns are first detected on physical examination.
Endoscopy: after the acute phase, if the condition is stable, it should be performed as early as possible to determine the extent of the lesion and to prevent the formation of obstruction due to stenosis.
Complications
Early complications of chemical burns of the esophagus include shock, laryngeal edema, tracheobronchitis, esophageal perforation, mediastinitis, and esophagotracheal fistula. Scarring stenosis is one of the long-term complications of esophageal burns. Not all chemical burns of the esophagus cause esophageal stenosis; it arises only in moderate and severe burns.
Treatment
1. Principles of treatment
The type of corrosive agent taken orally should be known, and early intravenous fluids should be given to supplement adequate nutrition, correct electrolyte and acid-base imbalance, and keep the airway open; fasting, gastric lavage is generally avoided to avoid perforation, and early surgery should be performed if there is any sign of esophageal or gastric perforation.
2. Reduce the damage secondary to corrosive agents
In order to reduce the absorption of poison and the degree of mucous membrane burn, those who swallow strong acid can drink water first, take aluminum hydroxide gel orally, or give buttermilk, egg white and vegetable oil orally as soon as possible; those who swallow strong alkali can give vinegar with warm water orally, generally should not take thick vinegar, because when thick vinegar and alkaline compounds are in action, the heat produced can aggravate the damage, and then take a small amount of egg white, buttermilk or vegetable oil again.
3.Symptomatic treatment
Those with severe pain should be given painkillers, such as morphine intramuscular injection; those with respiratory difficulty should be given oxygen inhalation; those with laryngeal edema and severe respiratory obstruction should be tracheotomized as early as possible, and broad-spectrum antibiotics should be applied to prevent secondary infection. In the early stage, in order to avoid the occurrence of laryngeal edema, adrenal glucocorticoids can be used within 24 hours of the onset of the disease, as appropriate, in order to reduce the local edema of the pharynx, and can reduce the formation of collagen and fibrous scar tissue. Hydrocortisone or dexamethasone can be used intravenously, and can be changed to prednisone tablets orally after a few days, but should not be taken for a long time.
4. Treatment of complications
If there are complications such as esophageal stenosis and pyloric obstruction, endoscopic balloon dilatation is feasible; in case of localized esophageal stenosis, implantation of stents is possible; those who are not suitable for dilatation or stenting should undergo surgical treatment.
Prevention
Strengthen the management to prevent self-administration or accidental administration of strong acid, alkali and other corrosive agents.