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Abstract：
BACKGROUND: Caustic ingestions are relatively uncommon, but remain a significant source of morbidity. Patients with caustic injury often undergo an urgent EGD, although it is not clear if an EGD is routinely needed in an asymptomatic patient. The study has two primary objectives; 1) to determine the utility of routine EGD in asymptomatic suicidal caustic ingestions; 2) to determine if asymptomatic unintentional acidic ingestions can be managed with observation alone, similar to basic ingestions.
METHODS: This retrospective study, which took place at 14 hospitals in three countries evaluated all patients who presented with a caustic ingestion between 2014-2020. The presence of symptoms and esophageal injury, demographic information, pH of ingested substance, reason for the ingestion, and outcome were recorded.
RESULTS: 409 patients were identified; 203 (46.9%) were male. The median (IQR) age was 18 (4-31) years; overall range 10 months to 78 years. Suicidal ingestions accounted for 155 (37.9%) of cases. Dysphagia or dysphonia were more likely in those with significant esophageal injury compared to those without (59.3% vs. 12.6% respectively; OR 10.1; 95% CI 4.43-23.1). Among 27 patients with significant esophageal injury, 48% were found in suicidal patients, compared with 51.9% in non-suicidal patients (p = NS). On multivariate regression, there was no difference in the rate of significant esophageal injury among suicidal vs. non suicidal patients (aOR 1.55; p = 0.45, 95% CI 0.45-5.33). Most ingestions involved basic substances (332/409; 81.2%). Unknown or mixed ingestions accounted for 25 (6.11%) of the ingestions. Significant esophageal burns were found in 6/52 (11.5%) of acid ingestions, compared with 21/332 (6.3%) of basic ingestions. Of the 42 cases of acidic ingestions without dysphagia or odynophagia, 2 (4.8%; 0.58-16.1%) had significant esophageal burns, compared with 9 (3.2%; 95% CI 1.4-5.9%) of the 284 basic ingestions; p = 0.64). On multivariate logistic regression, patients with acidic ingestions were not more likely to experience a significant burn (aOR 1.7; p = 0.11, 95% CI 0.9-3.1) compared to those with basic ingestions. No patient with significant esophageal burns was asymptomatic.
CONCLUSIONS: In this study, there was no statistical differences in the rates of significant burns between acidic and basic caustic ingestions. There were no significant esophageal injuries noted among asymptomatic patients.
METHODS: This retrospective study, which took place at 14 hospitals in three countries evaluated all patients who presented with a caustic ingestion between 2014-2020. The presence of symptoms and esophageal injury, demographic information, pH of ingested substance, reason for the ingestion, and outcome were recorded.
RESULTS: 409 patients were identified; 203 (46.9%) were male. The median (IQR) age was 18 (4-31) years; overall range 10 months to 78 years. Suicidal ingestions accounted for 155 (37.9%) of cases. Dysphagia or dysphonia were more likely in those with significant esophageal injury compared to those without (59.3% vs. 12.6% respectively; OR 10.1; 95% CI 4.43-23.1). Among 27 patients with significant esophageal injury, 48% were found in suicidal patients, compared with 51.9% in non-suicidal patients (p = NS). On multivariate regression, there was no difference in the rate of significant esophageal injury among suicidal vs. non suicidal patients (aOR 1.55; p = 0.45, 95% CI 0.45-5.33). Most ingestions involved basic substances (332/409; 81.2%). Unknown or mixed ingestions accounted for 25 (6.11%) of the ingestions. Significant esophageal burns were found in 6/52 (11.5%) of acid ingestions, compared with 21/332 (6.3%) of basic ingestions. Of the 42 cases of acidic ingestions without dysphagia or odynophagia, 2 (4.8%; 0.58-16.1%) had significant esophageal burns, compared with 9 (3.2%; 95% CI 1.4-5.9%) of the 284 basic ingestions; p = 0.64). On multivariate logistic regression, patients with acidic ingestions were not more likely to experience a significant burn (aOR 1.7; p = 0.11, 95% CI 0.9-3.1) compared to those with basic ingestions. No patient with significant esophageal burns was asymptomatic.
CONCLUSIONS: In this study, there was no statistical differences in the rates of significant burns between acidic and basic caustic ingestions. There were no significant esophageal injuries noted among asymptomatic patients.
摘要：
背景：苛性钠摄入相对不常见，但仍然是发病率的重要来源。患有腐蚀性损伤的患者通常会进行紧急EGD，尽管目前尚不清楚无症状患者是否需要进行EGD.该研究有两个主要目标：1）确定常规EGD在无症状性自杀性腐蚀性摄入中的效用；2）确定无症状的无意酸性摄入是否可以通过单独观察来管理，类似于基本摄取。
方法：本回顾性研究，这项研究在三个国家的14家医院进行，评估了2014-2020年间所有出现腐蚀性摄入的患者。症状和食道损伤的存在，人口统计信息,摄入物质的pH值，摄入的原因，并记录结果。
结果：409例患者中，203例（46.9%）为男性。中位（IQR）年龄为18（4-31）岁；总体范围为10个月至78岁。自杀摄入占155例(37.9%)。与没有明显食管损伤的患者相比，吞咽困难或发音困难的可能性更大（59.3％vs.分别为12.6%；OR10.1；95%CI4.43-23.1）。在27例严重食管损伤患者中，48%的人被发现有自杀倾向，非自杀患者为51.9%(p=NS)。关于多元回归，自杀与自杀之间的明显食道损伤率没有差异。非自杀患者(aOR1.55；p=0.45，95%CI0.45-5.33)。大多数摄入涉及碱性物质(332/409;81.2%)。未知或混合摄入占摄入的25（6.11％）。在6/52（11.5％）的酸摄入中发现明显的食管灼伤，与21/332（6.3%）的基本摄入相比。在42例无吞咽困难或吞咽困难的酸性摄入中，2例(4.8%;0.58-16.1%)有明显的食道烧伤,与284例基本摄入中的9例（3.2%；95%CI1.4-5.9%）相比；p=0.64）。在多元逻辑回归中，与有基本摄入的患者相比,有酸性摄入的患者更不可能出现显著烧伤(aOR1.7;p=0.11,95%CI0.9-3.1).无明显食管烧伤患者无症状。
结论：在这项研究中，酸性和碱性苛性碱摄入之间的显著烧伤率没有统计学差异。无症状患者中没有明显的食管损伤。
方法：本回顾性研究，这项研究在三个国家的14家医院进行，评估了2014-2020年间所有出现腐蚀性摄入的患者。症状和食道损伤的存在，人口统计信息,摄入物质的pH值，摄入的原因，并记录结果。
结果：409例患者中，203例（46.9%）为男性。中位（IQR）年龄为18（4-31）岁；总体范围为10个月至78岁。自杀摄入占155例(37.9%)。与没有明显食管损伤的患者相比，吞咽困难或发音困难的可能性更大（59.3％vs.分别为12.6%；OR10.1；95%CI4.43-23.1）。在27例严重食管损伤患者中，48%的人被发现有自杀倾向，非自杀患者为51.9%(p=NS)。关于多元回归，自杀与自杀之间的明显食道损伤率没有差异。非自杀患者(aOR1.55；p=0.45，95%CI0.45-5.33)。大多数摄入涉及碱性物质(332/409;81.2%)。未知或混合摄入占摄入的25（6.11％）。在6/52（11.5％）的酸摄入中发现明显的食管灼伤，与21/332（6.3%）的基本摄入相比。在42例无吞咽困难或吞咽困难的酸性摄入中，2例(4.8%;0.58-16.1%)有明显的食道烧伤,与284例基本摄入中的9例（3.2%；95%CI1.4-5.9%）相比；p=0.64）。在多元逻辑回归中，与有基本摄入的患者相比,有酸性摄入的患者更不可能出现显著烧伤(aOR1.7;p=0.11,95%CI0.9-3.1).无明显食管烧伤患者无症状。
结论：在这项研究中，酸性和碱性苛性碱摄入之间的显著烧伤率没有统计学差异。无症状患者中没有明显的食管损伤。
