What Is the Treatment of Caustic Esophageal Injury?
Caustic esophageal injury following ingestion of a corrosive substance demands immediate, coordinated intervention. The approach spans airway security, gastrointestinal protection, and multidisciplinary specialist involvement, and must be initiated without delay.
Airway and hemodynamic stabilization are the cornerstone of initial care. The extent of injury to the larynx and upper gastrointestinal tract drives the specific steps taken in the first minutes and hours after presentation.
Immediate management addresses the airway first — the method used depends on the degree of laryngeal and epiglottic involvement. Patients are kept fasting, and when signs of upper gastrointestinal injury are present, agents that reduce gastric acid and support mucosal protection are introduced.
Referrals to gastroenterology, surgery, and — where appropriate — psychiatry are part of the structured regimen. The complete protocol, including the full clinical algorithm and sequencing, is available via the link below.
References
DOI: 10.4292/wjgpt.v8.i2.90
- The cornerstone of all caustic ingestions is airway and hemodynamic stabilization.
- Intubation with direct visualization under fiberoptic laryngoscopy is most appropriate to avoid the risk of bleeding and further airway injury from "blind" airway access.
- If the epiglottis and larynx are edematous, tracheostomy should be performed.
- Upon admission, the patient should be kept fasting.
- Gastric acid suppression with H2 blockers or intravenous proton pump inhibitors are often initiated to allow faster mucosal healing and to prevent stress ulcers.
- Sucralfate is now a common adjunct in the management of acute ulcers.
- Referral to GI for endoscopy.
- Referral to surgery.
- Referral to psychiatry for non-accidental ingestions.