Endoscopic Grading as a Predictor to Develop Strictures in Corrosive Esophagitis in Children

Ioana Badiu Tisa; Lia Pepelea; Alexandru Pirvan; Iulia Lupan; Gabriel Samasca; Madalina Adriana Bordea

doi:10.3390/jcm12041699

Endoscopic Grading as a Predictor to Develop Strictures in Corrosive Esophagitis in Children

J Clin Med. 2023 Feb 20;12(4):1699. doi: 10.3390/jcm12041699.

Authors

Ioana Badiu Tisa^{1

2}, Lia Pepelea³, Alexandru Pirvan^{2

4}, Iulia Lupan⁵, Gabriel Samasca^{2

6}, Madalina Adriana Bordea^{2

3}

Affiliations

¹ Department of Mother and Child, Pediatric Clinic III, Iuliu Hatieganu University of Medicine and Pharmacy, 400217 Cluj-Napoca, Romania.
² Emergency Hospital for Children, 400001 Cluj-Napoca, Romania.
³ Department of Molecular Science, Microbiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400338 Cluj-Napoca, Romania.
⁴ Department of Mother and Child, Pediatric Clinic II, Iuliu Hatieganu University of Medicine and Pharmacy, 400177 Cluj-Napoca, Romania.
⁵ Department of Molecular Biology, Babes Bolyai University, 400371 Cluj-Napoca, Romania.
⁶ Department of Functional Biosciences, Immunology and Allergology, Iuliu Hatieganu University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania.

Abstract

Introduction: The incidence of corrosive esophagitis, also known as caustic esophagitis in children, is still increasing in developing countries, according to different clinical reports. Acids and alkalis are, in the same manner, involved in the pathogenesis of corrosive esophagitis in children. The aim of our study was to determine the incidence and endoscopic grading of corrosive esophagitis in a cohort of children from a developing country.

Materials and methods: We performed a retrospective analysis of all pediatric patients who were admitted for corrosive ingestion at Pediatric Clinic II, Emergency Hospital for Children, Cluj-Napoca, over 10 years.

Results: A total of 22 patients consisting of 13 (59.09%) girls and 9 boys (40.91%) were found in the present research. The majority of children lived in rural areas (69.2%). The results of laboratory tests were not well correlated with the degree of the injury. White blood cell counts over 20,000 cells/mm³, an increase in the C-reactive protein level and hypoalbuminemia were noticed only in three patients with strictures. The lesions were associated with increased levels of the pro-inflammatory cytokines, including interleukin (IL)-2, IL-5 and Interferon-gamma. Severe late complications such as strictures have been noticed in children with grade 3A injuries. The endoscopic dilation was done after the six months endoscopy. None of the patients treated with endoscopic dilation required surgical intervention for esophageal or pyloric perforation or dilation failure. The majority of complications (such as malnutrition) were noticed in children with grade 3A injuries. In consequence, prolonged hospitalization has been required. The second endoscopy (done six months after ingestion) revealed stricture as the most common late complication (n = 13, 60.60%: eight patients with grade 2B and five with grade 3A).

Conclusion: There is a low incidence of corrosive esophagitis in children in our geographic area. Endoscopic grading is a predictor of late complications such as strictures. Grade 2B and 3A corrosive esophagitis are likely to develop strictures. It is crucial to avoid strictures and to prevent malnutrition.

Keywords: corrosive esophagitis; grading; incidence.

Grants and funding

This research received no external funding.