Esophageal Injury

Question 1

Mechanism of eso caustic injury?

Answer 1

Acidic agents: coagulation necrosis –> limits penetration –> superficial mucosa

Alkaline agents: liquefaction necrosis –> rapid transmural –> risk of perforation

Question 2

Risk of caustic injury?

Answer 2

1. infection
2. inflammation –> necrosis
3. vascular thrombosis
4. perforation up to 3 wks post ingestion

Question 3

Grading system of eso injury

Answer 3

0. normal mucosa
1. superficial-mucosal edema and erythema
2. transmural- friability, erosion, hemorrhage
   A- superficial ulcers and non-transmural
   B- deep focal or transmural
3. ulceration with necrosis
   A- Deep ulcers + small area of necrosis
   B- extensive necrosis
4. perforation

Question 4

Stricture management?

Answer 4

most common complication

Grade 2A or higher —> barium esophagogram after 2-3wks

ballon dilation then repeat if needed

Question 5

Ca post caustic injury?

Answer 5

adenocarcinoma in 2% with severe caustic injury

Question 6

Pill esophagitis: examples, mechanism of injury and Rx

Answer 6

Eg: tetracycline, ferrous sulphate (acidic)
phenytoin (alkaline)

Mech: pill lodge in the eso wall and disintegrate –> local ulceration
RF: dysmotility, little water, anatomic abnormality

Rx: liquid form, ppi, sucralfate