Boukthir S, Fetni I, Mrad S Mazigh, Mongalgi M A, Debbabi A, Barsaoui S
Service de médecine infantile C, hôpital d'enfants de Tunis, Bab Saadoun, 1007 Tunis Jebbari, Tunisie.
Arch Pediatr. 2004 Jan;11(1):13-7. doi: 10.1016/j.arcped.2003.10.011.
Esophageal burns are frequent in some countries. Esophageal stricture is a severe complication after caustic ingestion. Its frequency is estimated to 5% and reaches 47% in severe esophagitis.
To study the influence of management of severe esophageal burns with high doses of steroids in the occurrence of esophageal stricture through the experience of an endoscopic unit.
Twenty-six children with a mean age of 3.5 years (15 months-8 years) with a second b- (N =22) or a third-degree (N =4) esophageal burns due to accidental ingestion of a caustic substance were included between 1993 and 1999. Corrosive substances ingested were sodium hydroxide (N =17), bleach (N =4), alkali (N =3), others (N =2). Upper GI endoscopy was performed in 17 children within the 24 hours of caustic ingestion and within the first 48 hours in all cases. All patients received methylprednisolone (1 g/1.73 m2/day) plus cimetidine and ampicillin plus early oral feeding resumption.
Three children (2 grade II et one grade I) were not controlled on day 30 of the protocol and have then been excluded. The remaining 23 children were divided in two groups depending on the upper GI endoscopic results: group I of 12 patients completely or partially healed and group II of 11 patients who developed an esophageal stricture. No difference was observed between the two groups with regard to the delay between caustic ingestion and the start of treatment and the number of shots of methylprednisolone. Second b- degree esophagitis complicated with an esophageal stricture underwent a median of five esophageal dilations (1-12). After a median follow-up of three years, four of them have a normal esophagus. All children with a third-degree esophagitis developed an esophageal stricture. One had a surgical replacement of the esophagus with a segment of colon with good outcome. The three others underwent a median of seven esophageal dilations (5-10). One of them has a normal esophagus after a follow-up of five years while the two others were lost to follow-up.
High dose of corticosteroids seems to improve second b-degree esophagitis prognosis and may prevent from esophageal stricture.
食管烧伤在一些国家很常见。食管狭窄是腐蚀性物质摄入后的严重并发症。其发生率估计为5%，在严重食管炎中可达47%。
通过一个内镜科室的经验，研究高剂量类固醇治疗严重食管烧伤对食管狭窄发生的影响。
1993年至1999年纳入26名平均年龄3.5岁（15个月至8岁）的儿童，他们因意外摄入腐蚀性物质导致二度（N = 22）或三度（N = 4）食管烧伤。摄入的腐蚀性物质为氢氧化钠（N = 17）、漂白剂（N = 4）、碱（N = 3）、其他（N = 2）。17名儿童在摄入腐蚀性物质后24小时内进行了上消化道内镜检查，所有病例均在48小时内进行。所有患者均接受甲泼尼龙（1 g/1.73 m²/天）加西咪替丁和氨苄西林，并尽早恢复经口喂养。
3名儿童（2名二度和1名一度）在方案第30天病情未得到控制，随后被排除。其余23名儿童根据上消化道内镜检查结果分为两组：I组12名患者完全或部分愈合，II组11名患者发生食管狭窄。两组在摄入腐蚀性物质至开始治疗的间隔时间和甲泼尼龙的注射次数方面未观察到差异。二度食管炎并发食管狭窄的患者平均接受了5次食管扩张（1至12次）。中位随访三年后，其中4名患者食管正常。所有三度食管炎儿童均发生食管狭窄。1名患者接受了结肠段食管置换手术，效果良好。另外3名患者平均接受了7次食管扩张（5至10次）。其中1名患者在随访五年后食管正常，另外2名失访。
高剂量皮质类固醇似乎可改善二度食管炎的预后，并可能预防食管狭窄。
