Hollenbach Marcus, Tünnemann Jan, Struck Manuel Florian, Feisthammel Jürgen, Schlosser Tobias, Schaumburg Tiffany, Mössner Joachim, Hoffmeister Albrecht
Medical Department II - Gastroenterology, Hepatology, Infectious Diseases, Pulmonology.
Department of Anaesthesiology and Intensive Care Medicine, University of Leipzig Medical Center, Leipzig, Germany.
Medicine (Baltimore). 2019 Aug;98(35):e16729. doi: 10.1097/MD.0000000000016729.
Caustic ingestion in adults is a rare but potentially life-threatening problem. It remains controversial whether endoscopic findings and mortality differ between acid and alkali ingestion. We compared ingestion of these agents and evaluated prediction parameters for survival and complications.Adult patients who presented with caustic ingestion were analyzed from 2005 to 2016. Mucosal injury was graded endoscopically by Zargar's score. Age, gender, intent of ingestion, caustic agents, comorbidities, management, complications, and mortality were examined.Thirty-one patients met inclusion criteria and were divided into acid (n = 10) and alkali group (n = 21). Ingestion of alkali resulted in higher grades (≥III) of esophageal (56% vs 24%, P = .01) and stomach injuries (43% vs 13%, P = .05) and was mostly done with suicidal intent (76% vs 30%, P = .003). Patients in the alkali group received more often surgical interventions, mechanical ventilation and tracheotomy. Overall complications including Zargar's-score ≥ grade III, mediastinitis, and aspiration pneumonia were higher in alkali group but all showed no statistical significance (P = .73). Mortality (acid: 1 (10%), alkali: 4 (19%), P = .52), age, gender, comorbidities, and intensive care management did not differ significantly between the groups. Chronic renal failure and mediastinitis were promising prediction parameters for mortality but did not reach statistical significance. No independent risk factors for the development of esophageal stenosis were identified.Alkaline agents caused a higher mucosal injury severity and were more often used in suicidal intent. Mediastinitis and chronic renal failure might be potential prediction parameters for survival but need to be evaluated in larger studies.
成人腐蚀性物质摄入是一个罕见但可能危及生命的问题。酸和碱摄入后的内镜检查结果及死亡率是否存在差异仍存在争议。我们比较了这些物质的摄入情况，并评估了生存和并发症的预测参数。
对2005年至2016年出现腐蚀性物质摄入的成年患者进行了分析。通过Zargar评分对黏膜损伤进行内镜分级。检查了年龄、性别、摄入意图、腐蚀性物质、合并症、治疗、并发症和死亡率。
31例患者符合纳入标准，分为酸摄入组（n = 10）和碱摄入组（n = 21）。碱摄入导致更高等级（≥III级）的食管损伤（56%对24%，P = 0.01）和胃损伤（43%对13%，P = 0.05），且大多是出于自杀意图（76%对30%，P = 0.003）。碱摄入组患者更常接受手术干预、机械通气和气管切开术。碱摄入组包括Zargar评分≥III级、纵隔炎和吸入性肺炎在内的总体并发症更高，但均无统计学意义（P = 0.73）。两组之间的死亡率（酸摄入组：1例（10%），碱摄入组：4例（19%），P = 0.52）、年龄、性别、合并症和重症监护治疗无显著差异。慢性肾衰竭和纵隔炎是有前景的死亡率预测参数，但未达到统计学意义。未发现食管狭窄发生的独立危险因素。
碱性物质导致更高的黏膜损伤严重程度，且更常用于自杀意图。纵隔炎和慢性肾衰竭可能是生存的潜在预测参数，但需要在更大规模的研究中进行评估。
