Division of Paediatric Gastroenterology, Department of Paediatrics, All India Institute of Medical Sciences, Rishikesh 249 203, India.
Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226 014, India.
Indian J Gastroenterol. 2021 Jun;40(3):316-325. doi: 10.1007/s12664-021-01153-z. Epub 2021 May 15.
Corrosive ingestion causes significant morbidity in children with no standard guidelines regarding management. This survey aimed to understand practices adopted by gastroenterologists, identify lacunae in evaluation and management and suggest a practical algorithm.
Indian gastroenterologists participated in an online survey (65 questions) on managing corrosive ingestion. When ≥ 50% of respondents agreed on a management option, it was considered as 'agreement'.
Ninety-eight gastroenterologists (72 pediatric) who had managed a total of ~ 2600 corrosive ingestions in the last 5 years responded. The commonest age group affected was 2-5 years (61%). Majority of ingestion was accidental (89%) with 80% due to improper corrosive storage. Ingestion of alkali and acid was equally common (alkali 41%, acid 39%, unknown 20%). History of inducing-vomiting after ingestion by community physicians was present in 57%. There was an agreement on 77% of questions. The respondents agreed on endoscopy (70%) and chest X-ray (67%) in all, irrespective of symptoms. Endoscopy was considered safe on days 1-5 after ingestion (91%) and relatively contraindicated thereafter. The consensus was to use acid suppression, always (59%); steroids, never (68%) and antibiotics, if indicated (59%). Feeding was based on endoscopic findings: oral in mild injuries and nasogastric (NG) in others. Eighty percent placed a NG tube under endoscopic guidance. Stricture dilatation was considered safe after 4 weeks of ingestion. Agreement on duration of acid suppression and stricture management (dilatation protocol and refractory strictures) was lacking.
Corrosive ingestion mostly affects 2-5-year olds and is accidental in majority. It can be potentially prevented by proper storage and labelling of corrosives. An algorithm for management is proposed.
腐蚀性摄入会导致儿童出现严重的发病率，但目前尚无针对其管理的标准指南。本研究旨在了解胃肠病学家采用的治疗方法，发现评估和管理方面的不足之处，并提出一个实用的算法。
印度胃肠病学家参与了一项关于腐蚀性摄入管理的在线调查（共 65 个问题）。当≥50%的受访者对某一管理方案达成一致时，则认为该方案存在“共识”。
共有 98 名（72 名为儿科）胃肠病学家参与了本次调查，他们在过去 5 年中总共管理了约 2600 例腐蚀性摄入病例。受影响最常见的年龄组是 2-5 岁（61%）。大多数摄入是意外（89%），其中 80%是由于腐蚀性物质储存不当导致的。摄入的碱性和酸性腐蚀性物质同样常见（碱性 41%，酸性 39%，未知 20%）。社区医生在摄入后诱导呕吐的情况占 57%。对于 77%的问题，受访者达成了共识。所有受访者都同意在任何情况下，无论症状如何，都应进行内镜检查（70%）和胸部 X 光检查（67%）。摄入后 1-5 天内进行内镜检查被认为是安全的（91%），而此后相对禁忌。共识是始终使用酸抑制治疗（59%）；从不使用类固醇（68%），仅在有指征时使用抗生素（59%）。喂养方式取决于内镜检查结果：轻度损伤时口服，其他情况时经鼻胃管（NG）喂养。80%的人在胃镜引导下放置 NG 管。摄入后 4 周时，扩张狭窄是安全的。对于酸抑制和狭窄管理（扩张方案和难治性狭窄）的持续时间，存在共识。
腐蚀性摄入主要影响 2-5 岁儿童，且多数为意外摄入。通过正确储存和标签腐蚀性物质，可以潜在地预防此类事件。本文提出了一个管理算法。
