UNASSIGNED: Ammonia solution (ammonium hydroxide) is used to convert cocaine hydrochloride to freebase cocaine. Due to its causticity, unintentional exposure to ammonia in a substance use context can result in injury. The objective of this study was to describe the characteristics of unintentional oral and buccal ammonia solution exposure in a substance use context.
UNASSIGNED: A retrospective study was conducted using the French poison centres database over a 10-year period (2009-2018).
UNASSIGNED: A total of 1,546 files were extracted, and 263 substance users were included. There was a significant increase in the number of these exposures between 2009 and 2018. Unintentional ingestion of ammonia solution was linked to product decanting in 89 per cent of cases. Substance use prior to the exposure and a festive context, such as free parties or teknivals, were identified in 25 per cent and 21 per cent of cases, respectively. Patients received a hospital examination in 87 per cent of cases. The severity of intoxication in substance users was graded as moderate (33 per cent) or severe (15 per cent) using the Poisoning Severity Score.
UNASSIGNED: The increased number of ammonia solution cases reported was consistent with an increase in the number of crack users in Europe in the same period. Ammonia solution exposure can suggest the possibility of substance use disorders. In such cases, patients can be referred to receive appropriate treatment and support. This study had some limitations, such as the lack of available information due to the retrospective nature of the study and the non-standardized questions asked by the poison centre during the medical phone interviews.
UNASSIGNED: Oral and buccal ammonia solution exposure in known substance users in France increased between 2009 and 2018. These users were mostly young men. A festive context and decanting were frequent. Patients were mainly referred to emergency departments to receive clinical examination and care. The potential severity of oral or buccal ammonia solution exposure in substance users requires increased vigilance among all healthcare professionals involved in the management of these intoxication cases.

Corrosive substance ingestion in children represents a significant public health issue due to its long-term health sequelae. Esophageal stricture, main complication of this dangerous condition, is treated by pneumatic dilation and eventually by esophageal replacement. We aimed, through this study, to report the outcomes of esophageal pneumatic dilation complicating corrosive substance ingestion in children in a developing country.
This cross-sectional study was performed on the population of pediatric patients with caustic esophageal stenosis between January 2005 and December 2020. All patients underwent pneumatic balloon dilation. A logistic regression model was built to predict the probability of the occurrence of the event (success/failure) of the dilation. The ROC curve is used to evaluate the performance of the logistic regression model to discriminate between positive and negative values of the dependent variable.
The success rate of pneumatic balloon dilation was 80.4%. The median duration of overall management was 11 months. The severity of caustic stricture observed during endoscopy was significantly linked to worse outcomes (p = 0.001). Multivariate analysis indicated that the severity of stenosis and the number of dilation sessions were independent risk factors for failure of dilation. ROC curve analysis showed that the area under the curve was 71.7%. A Cut-Off point value of 7 provided the best sensitivity and specificity.
Pneumatic balloon dilation has been proven to be efficacious in infants with caustic esophageal stricture. Pediatric surgeons should take into account factors to promptly switch to replacement surgery and avoid unnecessary and time-consuming serial dilations.

BACKGROUND: Children like to discover their environment by putting substances in their mouths. This behavior puts them at risk of accidentally ingesting foreign bodies (FBs) or harmful materials, which can cause serious morbidities.
OBJECTIVE: To study the clinical characteristics, diagnosis, complications, management, and outcomes of accidental ingestion of FBs, caustics, and medications in children.
METHODS: We conducted a retrospective cohort study of all children admitted for accidental ingestion to the Department of Pediatrics, Salmaniya Medical Complex, Bahrain, between 2011 and 2021. Demographic data, type of FB/harmful material ingested, and investigations used for diagnosis and management were recorded. The patients were divided into three groups based on the type of ingested material (FBs, caustics, and medications). The three groups were compared based on patient demographics, socioeconomic status (SES), symptoms, ingestion scenario, endoscopic and surgical complications, management, and outcomes. The FB anatomical location was categorized as the esophagus, stomach, and bowel and compared with respect to symptoms. The Fisher\'s exact, Pearson\'s χ2, Mann-Whitney U, and Kruskal-Wallis tests were used for comparison.
RESULTS: A total of 161 accidental ingestion episodes were documented in 153 children. Most children were boys (n = 85, 55.6%), with a median age of 2.8 (interquartile range: 1.8-4.4) years. Most participants ingested FBs (n = 108, 70.6%), 31 (20.3%) ingested caustics, and the remaining 14 (9.2%) ingested medications. Patients with caustic ingestion were younger at the time of presentation (P < 0.001) and were more symptomatic (n = 26/31, 89.7%) than those who ingested medications (n = 8/14, 57.1%) or FBs (n = 52/108, 48.6%) (P < 0.001). The caustic group had more vomiting (P < 0.001) and coughing (P = 0.029) than the other groups. Most FB ingestions were asymptomatic (n = 55/108, 51.4%). In terms of FB location, most esophageal FBs were symptomatic (n = 14/16, 87.5%), whereas most gastric (n = 34/56, 60.7%) and intestinal FBs (n = 19/32, 59.4%) were asymptomatic (P = 0.002). Battery ingestion was the most common (n = 49, 32%). Unsafe toys were the main source of batteries (n = 22/43, 51.2%). Most episodes occurred while playing (n = 49/131, 37.4%) or when they were unwitnessed (n = 78, 57.4%). FBs were ingested more while playing (P < 0.001), caustic ingestion was mainly due to unsafe storage (P < 0.001), and medication ingestion was mostly due to a missing object (P < 0.001). Girls ingested more jewelry items than boys (P = 0.006). The stomach was the common location of FB lodgment, both radiologically (n = 54/123, 43.9%) and endoscopically (n = 31/91, 34%). Of 107/108 (99.1%) patients with FB ingestion, spontaneous passage was noted in 54 (35.5%), endoscopic removal in 46 (30.3%), laparotomy in 5 (3.3%) after magnet ingestion, and direct laryngoscopy in 2 (1.3%). Pharmacological therapy was required for 105 (70.9%) patients; 79/105 (75.2%) in the FB group, 22/29 (75.9%) in the caustic group, and 4/14 (28.8%) in the medication group (P = 0.001). Omeprazole was the commonly used (n = 58; 37.9%) and was used more in the caustic group (n = 19/28, 67.9%) than in the other groups (P = 0.001). Endoscopic and surgical complications were detected in 39/148 (26.4%) patients. The caustic group had more complications than the other groups (P = 0.036). Gastrointestinal perforation developed in the FB group only (n = 5, 3.4%) and was more with magnet ingestion (n = 4) than with other FBs (P < 0.001). In patients with FB ingestion, patients aged < 1 year (P = 0.042), those with middle or low SES (P = 0.028), and those with more symptoms at presentation (P = 0.027) had more complications. Patients with complications had longer hospital stays (P < 0.001) than those without.
CONCLUSIONS: Accidental ingestion in children is a serious condition. Symptomatic infants from middle or low SES families have the highest morbidity. Prevention through parental education and government legislation is crucial.

UNASSIGNED: Compared to the prevalence and complications, there is still limited evidence in this regard.
UNASSIGNED: With an incidence rate of 200,000 cases annually and the induction of numerous complications, caustic ingestion imposes a significant burden on the healthcare system. Apart from being fatal in some cases, this injury affects its victims\' quality of life as it is followed by many gastrointestinal problems. This injury mainly occurs accidentally among children, whereas in adults, it often occurs with suicidal intentions. Despite recent advances in internal medicine, gastroenterology, and toxicology, this type of injury remains a debilitating and, in some cases, fatal disorder for its victims.
UNASSIGNED: This study retrospectively evaluated the clinical, laboratory, and endoscopic findings of 150 patients admitted to a referral center of toxicology and forensic medicine and assessed factors associated with each type of injury.
UNASSIGNED: The findings indicated a mortality rate as high as 7.3% in this population. Age, pH, and previous medical conditions were associated with more complications. Higher degrees of injury were also significantly associated with higher mortality. No significant difference was observed between types of corrosive substances.
UNASSIGNED: It seems that the most effective intervention for controlling caustic ingestion injuries would be psychiatric support, primary healthcare, and household education.

Caustic ingestion can lead to structural changes in the upper gastrointestinal tract. However, there are limited data on the effect of caustic ingestion on gastric secretion. This study was planned to determine the changes in gastric acid output in patients with caustic ingestion.
It was a prospective study done at a tertiary care center in northern India. Twenty consecutive patients in chronic phase of caustic ingestion were evaluated for the study. The gastric secretory function was estimated in the basal state and following pentagastrin stimulation. These results were compared with normal values for our laboratory.
The mean age of the included patients (n = 20) was 27.35 ± 2.96 years and 14 patients were male. Sixteen (80%) patients had a history of acid ingestion. Patients with caustic ingestion had significantly lower mean gastric acid secretion (0.8 ± 0.4 mEq/h vs. 4 ± 0.4 mEq/h; p < 0.001) compared to controls. After pentagastrin stimulation, the mean gastric juice volume (31.8 ± 6 mL/h vs. 62.3 ± 11.7 mL/h; p < 0.01) and acidity (15.3 ± 5.1 mEq/L vs. 39.6 ± 9.3 mEq/L; p < 0.001) increased in patients with caustic ingestion, but were lower than those in control subjects. Patients with a lower esophageal stricture (n = 6) had decreased maximum acid output (0.62 ± 0.32 mEq/h vs. 6.05 ± 0.55 mEq/h; p < 0.05) compared to patients with stricture in the upper or middle esophagus.
Caustic ingestion is associated with reduced gastric juice volume and acid output. Patients with stricture in the lower one third of the esophagus are at a higher risk of hypochlorhydria compared to patients with stricture in either the upper or middle esophagus.

Esophageal strictures resulting from caustic ingestion in children are usually difficult to be managed, and surgical replacement is usually required for cases refractory to frequent dilatation sessions. Topical Mitomycin C (MMC) has been recently used in the management of resistant strictures. We evaluated the efficacy of MMC application in treatment of long refractory caustic esophageal strictures.
This prospective study included 120 patients of both sexes with refractory caustic long esophageal strictures (> 3 cm in length). All patients were randomly divided into two equal groups using the research randomizer program (1:1 randomization), group I underwent endoscopic dilatation therapy only and group II underwent dilatation with topical application of MMC. Follow-up was done regularly by assessing the dysphagia score and patients were evaluated after 6 months of management. The procedure was repeated four times with 2-week intervals. Complete relieve of symptoms (dysphagia score = 0) was assessed after the follow-up period.
The complete cure was detected in 81.6% of patients in the MMC group compared to only 40% in the first group, p-value < 0.0001. During the follow-up, the average sessions of dilatation needed in group II were 3.25 ± 2.78 compared to 6.25 ± 1.74 sessions in group I (p < 0.001). The mean cost of sessions in patients who showed symptomatic and endoscopic improvement was significantly lower in group II (272.2 ± 51 US$) when compared to group I (404 ± SD 55.7 US$).
Cure rate was double in the MMC group. MMC application significantly improved symptoms and reduced both the number and frequency of dilatations to alleviate dysphagia in patients with refractory caustic esophageal strictures and hence reduced the cost of treatment.

BACKGROUND Caustic ingestion is one of the most important injuries during childhood, which leads to serious sequel. In this study, we evaluated the clinical manifestations, endoscopic appearance, complications, and treatment results in patients with caustic ingestion in our hospital. METHODS Hospital chart of patients with caustic ingestion who admitted to Nemazee Teaching Hospital affiliated to Shiraz University of Medical Sciences during a 2-year period (2015-2016) were reviewed retrospectively. The age, sex, nature of the caustic agent, clinical presentations, grade of injury in endoscopy, degree of parents\' education, site of ingestion, accidental or intentional attempts, complications, and outcomes were reviewed. RESULTS In this study the charts of 41 patients (26 boys and 15 girls) with caustic ingestion over the 2-year period were reviewed. The mean age of the patients was 4.4 year. Of them, 95.1% had ingested the materials accidentally, and 2 (4.9%) patients had ingested unknown substances for suicidal attempt. Of all cases, 68.3% of caustic ingestion occurred in the kitchen. 19 (46.3%) agents were acidic substances and 17 (41.5%) were alkali agents. 5 (12.1%) patients ingested unknown substances. 24.3% of the patients were asymptomatic and the most common presentation was drooling (34.14%). 26.8% of the patients had dysphagia, and 24.3% presented with oral ulcer. 7.3% had abdominal pain, 4.8% had fever, and 2.4% had hematemesis. 14 (34.1%) patients had normal feature, 6 (14.6%) had grade I injury, 12 (29.3%) had grade II injury, and 8 (19.5%) had grade III injury in endoscopic evaluation. CONCLUSION Most of the caustic ingestion occurred in kitchen. Male was the dominant sex in the caustic injury.