Abstract

There is no standard treatment protocol for acute corrosive injury of esophagus and most patients are treated with proton pump inhibitors (PPIs). However clinical studies evaluating efficacy of PPIs in caustic injury are lacking. We conducted a prospective observational study where 55 consecutive patients presenting to Madras Medical College Hospital and Research Center, Chennai with alleged history of corrosive ingestion meeting study criteria were included in the study. Data was obtained on the agent and amount of corrosive ingestion. Initial esophago-gastro-duodenoscopy (EGD) was done within 24 hours of consumption of corrosive agent and injury to esophagus graded according to Zargar classification. All patients with mucosal injury received 80mg intravenous pantoprazole stat followed by 8mg/hr infusion. Second upper gastrointestinal (UGI) endoscopy limited to assessment of esophageal injury was performed after 72 hours of high dose PPI. Mucosal healing is seen by 1 grade in 76.6% and by 2 grades in 20% of patients receiving high dose pantoprazole. 1 patient with grade 3 injury did not show improvement in grade of injury. None of the patients had worsening of injury grade. High dose pantoprazole helps in mucosal healing in acute corrosive injury of esophagus and should form integral part of treatment of acute corrosive injury.

Key words: Esophageal injury, Corrosive, Esophago-gastro-duodenoscopy (EGD), Mucosal healing, Proton pump inhibitor (PPI), Zargar Grading