Department of Surgical Sciences, University of Parma, 43125 Parma, Italy.
World J Gastroenterol. 2013 Jul 7;19(25):3918-30. doi: 10.3748/wjg.v19.i25.3918.
Prevention has a paramount role in reducing the incidence of corrosive ingestion especially in children, yet this goal is far from being reached in developing countries, where such injuries are largely unreported and their true prevalence simply cannot be extrapolated from random articles or personal experience. The specific pathophysiologic mechanisms are becoming better understood and may have a role in the future management and prevention of long-term consequences, such as esophageal strictures. Whereas the mainstay of diagnosis is considered upper gastrointestinal endoscopy, computed tomography and ultrasound are gaining a more significant role, especially in addressing the need for emergency surgery, whose morbidity and mortality remains high even in the best hands. The need to perform emergency surgery has a persistent long-term negative impact both on survival and functional outcome. Medical or endoscopic prevention of stricture is debatable, yet esophageal stents, absorbable or not, show promising data. Dilatation is the first therapeutic option for strictures and bougies should be considered especially for long, multiple and tortuous narrowing. It is crucial to avoid malnutrition, especially in developing countries where management strategies are influenced by malnutrition and poor clinical conditions. Late reconstructive surgery, mainly using colon transposition, offers the best results in referral centers, either in children or adults, but such a difficult surgical procedure is often unavailable in developing countries. Possible late development of esophageal cancer, though probably overemphasized, entails careful and long-term endoscopic screening.
预防在减少腐蚀性摄入的发生率方面起着至关重要的作用，尤其是在儿童中，但这一目标在发展中国家远未实现，在这些国家，此类伤害基本上没有报告，其真实流行情况根本无法从随机文章或个人经验中推断出来。特定的病理生理机制越来越被理解，可能在未来的管理和预防长期后果（如食管狭窄）方面发挥作用。虽然上消化道内窥镜检查被认为是诊断的主要方法，但计算机断层扫描和超声检查正在发挥更重要的作用，尤其是在需要紧急手术时，即使在最好的情况下，其发病率和死亡率仍然很高。需要进行紧急手术对生存和功能结果都有持久的负面影响。医学或内镜预防狭窄存在争议，但食管支架，无论是可吸收的还是不可吸收的，都显示出有希望的数据。扩张是治疗狭窄的首选方法，对于长、多和弯曲的狭窄，应考虑使用探条。避免营养不良至关重要，特别是在发展中国家，那里的管理策略受到营养不良和较差的临床条件的影响。晚期重建手术，主要使用结肠移位，在转诊中心为儿童或成人提供最佳结果，但这种困难的手术在发展中国家往往无法进行。尽管可能被过分强调，但可能会出现晚期食管癌，需要进行仔细和长期的内镜筛查。
