LYE-INDUCED ESOPHAGITIS: COURSE AND FOLLOW UP OF 29

PATIENTS. M. Yasser F Abu Safieh M.D. Nablus -West Bank.

Introduction: Lye is a household detergent, used in small villages in the

West Bank, for home made soap, accidental ingestion of this corrosive during

childhood, will induce acute alkaline esophagitis followed by a stricture in

lower and middle esophagus.

Aim: The aim of this study is to evaluate the chronic sequel of lye

esophagitis, management of the stricture, morbidity and mortality of repeated

dilation, and colonic interposition.

Materials & Methods: Twenty nine patients were diagnosed between 1990-

1997. All have had accidental ingestion of lye during childhood. The majority

presented to a pediatrician or general practitioner immediately after ingestion

and used to be referred for:- I- Dilation after development of the stricture,

2-Urgent gastroscopy for impacted food in upper esophagus, and 3- Dilation

of post colonic interposition stricture. All patients have had gastroscopy, and

Ba-swallow to estimate the size of the stricture. Patients with impacted food

and dysphagia to fluids had emergency gastroscopy and removal of impacted

food by a snare. Dilation of the stricture by Savary-Gilliard dilators{5-18

mm}, passed over a guide wire, was done under fluoroscopy.

Results: Twenty nine patients are: {20 M, 9 F}, Age at ingestion (1.25--5

mean 3year). Age at referral (2--55 mean 11 year). All presented with

dysphagia, ten patients had impacted food pieces that needed urgent

gastroscopy to relieve obstruction. All strictures were in middle and distal

esophagus, average length 1-6cm. Twenty two patients(group A) were below

12 years, and (7) patients (group B) were above 12 years.

In group A (18/22) had repeated dilation with average last size achieved by

9--14mm dilators. One child died post thoracotomy for perforation after the

first dilation. (8) patients had minimal bleeding (4) children didn't come for

the first dilation (3) of them presented with more than one episode of

impacted food. For the last 30 months (13/17pts 76%) of group A, did not

have dilation.

Group B (7 pts) above 12 yrs. (4) had colonic interposition because of failed

or complicated dilation, (3) of them had post operative stricture and undergo

dilation, the most severe one, has had injection of steroid in 4 quadrant of the

stricture and 15 mm. dilator could pass easily after 3 weeks of injection.

While (3) patients had the first dilation at age 22, 25, and 55 years. In group

B, (2 pts) were admitted for observation because of severe chest pain, after

dilation, but perforation could not be confirmed. (2pts) had minimal bleeding.

The average last size achieved by 12--16mm dilators. From this group only

(4/7 pts 57%) didnot come for dilation for the last 20 months.

Conclusion: Accidental ingestion of lye occurs in young children, it is clear

that some sort of adaptation to dysphagia occurs with age. The majority have

good dilation of the stricture by Savary-Gilliard dilators, childhood strictures

have a better success rate of dilation. The risk of perforation and death, or

minor inevitable complications will not preclude dilation. Colonic

interposition is a modality of treatment with postoperative stricture which

requires dilation.

Published in Gastroenterology, Vol: 114 supplement April 1998

Presented as a poster in DDW