Introduction
Corrosive esophagitis is an injury to the esophagus mainly caused by ingesting harmful chemical agents like detergents, bleaches, etc., that can cause bleeding, perforation, or a stricture. Early endoscopic intervention is useful in cases suspected of corrosive esophagitis in determining the extent of the injury and the recovery rate.
What Is Corrosive Esophagitis?
Corrosive esophagitis is an injury to the esophagus mainly caused by ingesting harmful chemical agents like detergents, bleaches, etc., that can cause bleeding, perforation, or a stricture. In the west, many cases of alkaline ingestion were reported. In Asia, however, the ingestion of acidic chemicals was reported more. This is probably due to the lower price of acidic chemicals and their easy availability in the Asian region. Substances that are very acidic or very alkaline can damage the GI tract. The injury's severity depends upon the substance's concentration, how much of it is ingested, the time taken before treatment begins, and the substance's pH.
Early endoscopic intervention is useful in cases suspected of corrosive esophagitis, not only in determining the extent of the injury but also in determining the recovery rate. In severe cases, a high degree of corrosive esophagitis can result in esophageal bleeding, perforation, and death.
High mortality and morbidity rates are associated with upper GI tract injuries with caustic substances. This is particularly true when mediastinitis (swelling and irritation in the chest, in the area between the lungs), chemical peritonitis (a thin layer of tissue inside the abdomen called the peritoneum gets inflamed), or perforation of the GI tract occurs as a result of ingestion of a harmful substance. Esophageal stricture, one of this condition's complications, may require repetitive ballooning procedures to be rectified completely. In addition, there can be other health conditions like acid reflux, which can cause inflammation of the esophagus.
What Is the Pathophysiology of Corrosive Esophagitis?
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Chemical substances that are very acidic or alkaline (with a pH less than two or greater than 12) can cause severe injury to the GI tract. Acidic and alkaline substances cause different types of tissue damage.
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Alkaline substances are usually available as colorless, odorless, and tasteless and are usually ingested more. When ingested, they react with the proteins and fats to form proteinase, causing liquefactive necrosis (a type of necrosis that causes the tissues to be transformed into a liquid mass dense in nature). This leads to injury to deeper tissues and transmural injury (injury to the heart tissues).
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Acids, in contrast, have an unpleasant taste and an irritable smell and are usually ingested in small quantities and swallowed quickly. The ingested acid reacts with the proteins in the tissue and forms acid proteins.
- Tissue injury during acid ingestion is coagulation necrosis (a type of cell death due to the lack of proper blood supply). The lump formed, as a result, prevents deeper tissue damage and transmural injury. However, it can also depend upon the strength of the acid ingested, its penetrative capacity, etc.
What Are the Symptoms of Corrosive Esophagitis?
The common symptoms of corrosive esophagitis are:
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Chest pain of sudden onset (immediately after the substance is ingested).
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Pain while trying to swallow food or liquid.
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Loss of appetite.
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Bleeding, as in vomiting blood or blood in the stool.
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Burning sensation in the esophagus.
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A feeling that something is stuck to the chest or heaviness in the chest.
What Are the Causes of Corrosive Esophagitis?
The tissues lining the esophagus are very sensitive and can easily be damaged. There are several causes of corrosive esophagitis. Some of them include the following;
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Stomach Acid Reflux: The regurgitation of acid from the stomach is one of the most common causes of esophagitis. This is commonly seen in gastroesophageal reflux syndrome (GERD). Pregnancy, obesity, smoking, alcohol consumption, fatty and spicy food, etc., are other factors that can cause acid reflux.
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Excessive Vomiting: The acid released while vomiting can affect the esophagus.
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Pills: Pills getting stuck in the esophagus: This usually occurs when adequate water is not present to swallow the pill or due to the narrowing of the esophagus.
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Infections: Some infections like viral (herpes, cytomegalovirus), fungi (candida), or bacteria can cause inflammation of the esophagus. This is generally found in immunocompromised patients (those who lack immunity).
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Radiation Therapy: Radiation therapy of the head and neck can cause inflammation of the esophagus.
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Ingestion of Harmful Chemicals: It can be life-threatening and even cause death.
Who Is at Higher Risk of Corrosive Esophagitis?
Individuals who are at higher risk of developing corrosive esophagitis include:
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Radiation Therapy.
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Certain Medications: Medications like antibiotics, drugs for weak bones, etc.
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Narrow esophagus: Esophagitis can occur due to some health conditions or due to surgery that was done previously.
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Pills: Pills that got stuck in the esophagus.
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Dry Mouth: The condition can be caused by conditions due to the lack of saliva production.
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Heart Conditions: Heart conditions can enlarge the heart, narrowing the opening of the esophagus.
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Digestive Changes.
How Is Corrosive Esophagitis Diagnosed?
A detailed case history can be taken if the patient is conscious of getting information on what chemical was ingested, the duration after ingestion, history of acid reflux, etc. Tests that can be done to diagnose the condition include:
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Endoscopy: This is used to visualize the esophagus and understand the condition's severity.
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Fluoroscopy (Barium Swallow): Barium swallow is the initial and diagnostic test of choice in patients with dysphagia. It helps detect obstruction in the lumen of the esophagus. It is also called an esophagram. It is an imaging technique using a special type of X-ray called fluoroscopy. It shows the organs moving in real-time. The person undergoing this procedure is made to drink a chalky fluid containing barium. The presence of barium in the blood enables us to see the internal organs more clearly.
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Biopsy: A biopsy can be done if necessary to rule out malignancy.
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Culture: Culture can be done to find the microorganism causing infection.
How Is Corrosive Esophagitis Treated?
The treatment of corrosive esophagitis depends on the underlying cause.
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If any medicine is associated with esophagitis, it can be stopped, and an alternative drug can be given. Meanwhile, medications to alleviate the condition can be provided. Medications to reduce irritation to the esophageal mucosa can be given. This can protect the mucosa from further destruction. Dilation can be done if the esophagus is narrow and has caused an obstruction, leading to esophagitis.
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If the underlying cause is a caustic injury (ingestion of a harmful chemical), immediate resuscitation and the extent of damage need to be evaluated. In this case, the first line of treatment is airway and hemodynamic stabilization (proper blood supply to the organs). Since the causative agent would have affected the upper respiratory tract, it should be evaluated, and intubation (inserting a tube through the mouth or nose) or tracheostomy (a tube inserted in the windpipe to help with breathing) should be done if required.
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Gastric acid suppression with H2 blockers can be given to heal mucosal ulcers. Antibiotics can be given to prevent secondary infections.
Conclusion
Early endoscopic intervention is useful in cases suspected of corrosive esophagitis, not only in determining the extent of the injury but also in determining the recovery rate. In severe cases, a high degree of corrosive esophagitis can result in esophageal bleeding, perforation, and death. High mortality and morbidity rates are associated with severe caustic upper GI tract injuries.
