Corrosive injury of the esophagus in children; failure of corticosteroid treatment reemphasizes prevention

Article Abstract:

Despite public education and the widespread use of child-resistant packaging, there are an estimated 1.2 million accidental poisonings of children under age six each year in the United States. In many cases, the substance ingested is a household product. In general, ingestion of poisonous substances is more common and has less serious health effects in children than in teenagers and adults. However, an important exception to this trend are caustic and corrosive agents. These substances include drain cleaners, lye, oven and toilet-bowl cleaners, laundry and dishwasher detergents, and small batteries used in watches and cameras. The injuries caused by swallowing these substances are usually severe, whether the material is an alkali or an acid. The esophagus, the muscular tube that conveys food from the mouth to the stomach, is burned by the corrosive material. There has been some controversy regarding the best medical treatment for caustic injury to the esophagus. One therapy that has been used is corticosteroid drugs, which reduce inflammation in the body. It is hoped that these drugs will prevent the formation of esophageal strictures, which narrow the passage through the esophagus and may even necessitate esophageal removal and replacement. There have been several studies evaluating the usefulness of steroids in these cases, but flaws in methodology have rendered them inconclusive. A study by Anderson and colleagues in the September 6, 1990 issue of the New England Journal of Medicine conclusively shows that steroids are not effective in most cases of corrosive esophageal injury. This means that no effective medical treatment is available, which increases the need for preventing these accidental poisonings. (Consumer Summary produced by Reliance Medical Information, Inc.)

Safety and security measures, Prevention, Poisons, editorial

---

A controlled trial of corticosteroids in children with corrosive injury of the esophagus

Article Abstract:

Many cleaners used in the home are caustic, and can cause serious and even fatal injury if ingested. Even though public awareness has been raised and containers have been designed to be childproof, accidental poisonings of young children continue to occur. One serious effect of swallowing caustic substances is burning of the esophagus, the muscular tube that carries food from the mouth to the stomach. These burns can lead to strictures of the esophagus, which involve constriction, or narrowing, of the passageway. A major goal of medical intervention in these cases is to prevent strictures from developing. Methods of treatment have changed in the past 20 years, and the best approach has not yet been determined. Treatments include dilation of the esophagus, the use of stents or tubes to hold the esophagus open, and corticosteroid medications, which are thought to reduce the inflammatory response. The value of steroids in preventing strictures after ingestion of caustic substances was assessed in this study. Over an 18-year period, 60 children were assigned to either receive or not receive steroid therapy after esophageal injury from a caustic substance. The average patient age was two years. The steroid regimen began with intravenous prednisolone, which was replaced with oral prednisone for a total of three weeks. There was no difference between groups in the percentage of children who developed strictures (about one-third in each group) or the percentage who needed esophageal replacement. It was concluded that strictures developed in children with the most severe injuries, and steroids had preventative benefits. (Consumer Summary produced by Reliance Medical Information, Inc.)

---

The use of digoxin-specific Fab fragments for severe digitalis intoxication in children

Article Abstract:

Antibody fragments that specifically bind to digoxin may be effective in treating children who experience toxic side effects from the drug. Twenty-nine children with severe digoxin toxicity were treated with Fab antibody fragments at 21 hospitals between 1974 and 1986. Seventy-six percent of the children had atrioventricular block. In 93% of the children, Fab successfully countered the digoxin side effects. In 19 children, the average time until Fab began working was 25 minutes, and symptoms completely resolved in an average of 90 minutes. Seven children died, but none of the deaths were related to Fab treatment. Children who are known to have ingested more than 0.3 milligrams of digoxin per kilogram of body weight or who have blood levels of digoxin higher than 5 nanograms per milliliter should be treated with Fab.

Health aspects, Digoxin, Antibodies

Similar abstracts:

• Abstracts: Recognition of gonadotroph adenomas in women. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis
• Abstracts: Criteria for recognition of the growth-inefficient child who may respond to treatment with growth hormone
• Abstracts: Criteria for recognition of the growth-inefficient child who may respond to treatment with growth hormone. part 2
• Abstracts: The reliability of the medical history in the identification of patients at risk for infective endocarditis. The evidence base for the efficacy of antibiotic prophylaxis in dental practice
• Abstracts: Optimal etching time of glass ionomer cement for maximum bond of composite resin. The glass ionomer cement

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.