Gupta S K, Croffie J M, Fitzgerald J F
Department of Pediatrics, Indiana University School of Medicine, James Whitcomb Riley Hospital for Children, Indianapolis, Indiana 46202-5225, USA.
J Pediatr Gastroenterol Nutr. 2001 Jan;32(1):50-3. doi: 10.1097/00005176-200101000-00015.
It is unclear whether symptoms alone can identify patients with caustic ingestion who will benefit from esophagogastroduodenoscopy (EGD). The published data are contradictory. The purpose of the current study was to determine the relationship between initial symptoms and EGD findings in patients with caustic ingestion.
Chart review of all caustic ingestions who underwent EGD during a 4-year period (December 1993 through November 1997).
Twenty-eight patients (15 girls; mean age, 2.7 years (range, 0.92-13.33) underwent EGD after caustic ingestion. Fourteen percent (4/28) of patients were asymptomatic, and findings on endoscopy were normal. Another 57% (16/28) had normal endoscopic findings, although all were symptomatic. Twenty-nine percent (8/28) of patients had esophageal injury on EGD, and all were symptomatic. Esophageal injury was graded as 1 (mucosal erythema), 2 (superficial burns; noncircumferential) or 3 (deep burns; circumferential). The injury was grade 1 in three of eight patients and grade 2 in two; all had one symptom each. Grade 3 injury was found in three of eight patients: two had two symptoms (drooling and vomiting, drooling and stridor), and one had one symptom (dysphagia). All patients with grade 3 injury subsequently underwent esophageal dilations. Follow-up information was secured for two of the three patients with grade 1 injury and both patients with grade 2 injury at 34.3 months (range, 24-50) after the ingestion, and all were asymptomatic. Of the 20 patients with absence of esophageal mucosal damage, follow-up data were available for 15 patients at 37.2 months (range, 7-63) after the event and all were well.
All patients with clinically significant injury (grades 2 and 3) were symptomatic at initial assessment. No single symptom or combination of symptoms could identify all patients with esophageal injury. All asymptomatic patients had normal findings on endoscopic examinations. Esophagogastroduodenoscopy seems unnecessary in asymptomatic patients with alleged caustic ingestion. A larger, prospective study would be necessary to unequivocally answer this clinically important question.
仅靠症状是否能识别出因腐蚀性物质摄入而将从食管胃十二指肠镜检查（EGD）中获益的患者尚不清楚。已发表的数据相互矛盾。本研究的目的是确定腐蚀性物质摄入患者的初始症状与EGD检查结果之间的关系。
回顾性分析1993年12月至1997年11月期间接受EGD检查的所有腐蚀性物质摄入患者的病历。
28例患者（15名女孩；平均年龄2.7岁，范围0.92 - 13.33岁）在腐蚀性物质摄入后接受了EGD检查。14%（4/28）的患者无症状，内镜检查结果正常。另有57%（16/28）的患者内镜检查结果正常，尽管他们均有症状。29%（8/28）的患者在EGD检查时有食管损伤，且均有症状。食管损伤分为1级（黏膜红斑）、2级（浅表烧伤；非环形）或3级（深度烧伤；环形）。8例患者中有3例损伤为1级，2例为2级；所有患者各有1种症状。8例患者中有3例为3级损伤：2例有2种症状（流涎和呕吐、流涎和喘鸣），1例有1种症状（吞咽困难）。所有3级损伤患者随后均接受了食管扩张术。在摄入后34.3个月（范围24 - 50个月），获得了3例1级损伤患者中的2例以及2例2级损伤患者的随访信息，所有患者均无症状。在20例无食管黏膜损伤的患者中，15例患者在事件发生后37.2个月（范围7 - 63个月）有随访数据，且均情况良好。
所有具有临床显著损伤（2级和3级）的患者在初始评估时均有症状。没有单一症状或症状组合能够识别所有食管损伤患者。所有无症状患者的内镜检查结果均正常。对于疑似腐蚀性物质摄入的无症状患者，食管胃十二指肠镜检查似乎没有必要。需要进行更大规模的前瞻性研究来明确回答这个临床上重要的问题。
