University Tunis El Manar, Faculty of medicine of Tunis, Tunisia; Pediatric Department C, Bechir Hamza Children's hospital Tunis, Tunisia.
University Tunis El Manar, Faculty of medicine of Tunis, Tunisia; Pediatric Department C, Bechir Hamza Children's hospital Tunis, Tunisia.
Arch Pediatr. 2022 Nov;29(8):573-580. doi: 10.1016/j.arcped.2022.08.019. Epub 2022 Oct 6.
The ingestion of caustic substances remains a serious medical problem in Tunisian children. This study was conducted to describe the epidemiological, clinical, and endoscopic findings of caustic ingestion in Tunisian children, and to indentify predictive factors of severe esophageal and gastric injuries.
A retrospective review of all children referred to a tertiary pediatric center for caustic ingestion who underwent esophago-gastro-duodenoscopy was conducted. Severe esophageal and gastric injuries were defined as Grade 2b, 3a, 3b, and 4 using the Zargar classification. We conducted multivariate logistic regression analysis to identify predictive factors for severe esophageal and gastric caustic injuries.
We analyzed 1059 diagnostic procedures performed for caustic ingestion. The mean age was 41.4± 31.9 months. The most frequently ingested caustic substance was household bleach followed by caustic soda granules. Endoscopy showed severe esophageal and gastric lesions, respectively, in 122 (11.5%) and 56 (5.3%) cases. Predictive factors of severe esophageal injuries were: alkaline ingestion (p<0.001; OR: 17.9; 95% CI: 8.4-38.1) and the presence of symptoms after caustic ingestion (p=0.02; OR: 2.4; 95% CI: 1.1-5.4). The occurrence of complications was significantly associated with the presence of severe gastric lesions at the initial procedure (p=0.046; OR: 2.3;95% CI: 0.9- .3).
Esophago-gastro-duodenoscopy should always be performed for symptomatic children, asymptomatic children who have ingested an alkaline product, and asymptomatic children under the age of 6 years.
腐蚀性物质摄入在突尼斯儿童中仍是一个严重的医学问题。本研究旨在描述突尼斯儿童腐蚀性摄入的流行病学、临床和内镜表现，并确定严重食管和胃损伤的预测因素。
对所有因腐蚀性摄入而转诊至三级儿科中心并接受食管胃十二指肠镜检查的儿童进行了回顾性研究。根据 Zargar 分级，严重食管和胃损伤定义为 2b、3a、3b 和 4 级。我们进行了多变量逻辑回归分析，以确定严重食管和胃腐蚀性损伤的预测因素。
我们分析了 1059 例因腐蚀性摄入而进行的诊断性检查。平均年龄为 41.4±31.9 个月。最常摄入的腐蚀性物质是家用漂白剂，其次是苛性苏打颗粒。内镜检查分别显示 122 例（11.5%）和 56 例（5.3%）严重食管和胃损伤。严重食管损伤的预测因素为：碱性物质摄入（p<0.001；OR：17.9；95%CI：8.4-38.1）和腐蚀性摄入后出现症状（p=0.02；OR：2.4；95%CI：1.1-5.4）。并发症的发生与初始检查时严重胃损伤的存在显著相关（p=0.046；OR：2.3；95%CI：0.9-0.3）。
对于有症状的儿童、摄入碱性物质的无症状儿童和 6 岁以下的无症状儿童，应始终进行食管胃十二指肠镜检查。
