High Doses of Methylprednisolone in the Management of Caustic Esophageal Burns
- 1 June 2014
- journal article
- research article
- Published by American Academy of Pediatrics (AAP) in PEDIATRICS
- Vol. 133 (6), e1518-e1524
- https://doi.org/10.1542/peds.2013-3331
Abstract
OBJECTIVE: Caustic substance ingestion in childhood is a public health issue in developing countries, and several management protocols have been proposed to prevent the resulting esophageal strictures. The role of corticosteroids in preventing corrosive-induced strictures is controversial. Our aim was to study the influence of high doses of corticosteroids in preventing esophageal strictures. METHODS: Eighty-three children with a mean age of 4.10 ± 2.63 years and with grade IIb esophageal burns (an esophagogastroscopy was performed within 24–48 hours of injury) due to corrosive substance ingestion were enrolled in our study between 2005 and 2008. Forty-two children (study group) received methylprednisolone (1 g/1.73 m2 per day for 3 days), ranitidine, ceftriaxone, and total parenteral nutrition. Forty-one children (control group) were administered the same regimen excluding methylprednisolone. Stricture development was compared between groups based on endoscopic and radiologic findings. RESULTS: During the endoscopic examination, stricture development was observed in 4 patients (10.8%) in the study group and in 12 patients (30%) in the control group. The difference was statistically significant (P = .038). The stricture development rate in the upper gastrointestinal system with barium meal was 14.3% and 45.0% in the study and control groups, respectively. The difference was statistically significant (P = .004). The duration of total parenteral nutrition was shorter in the study group compared with the control group (P = .001). High doses of methylprednisolone were well tolerated in the study group without any side effects. CONCLUSIONS: High doses of methylprednisolone used for the management of grade IIb esophageal burns may reduce stricture development.Keywords
This publication has 14 references indexed in Scilit:
- Updates on the Evaluation and Management of Caustic ExposuresEmergency Medicine Clinics of North America, 2007
- THE EFFECT OF STEROID THERAPY ON SEVERE CORROSIVE OESOPHAGEAL BURNS IN CHILDREN: A MULTICENTRIC PROSPECTIVE STUDYJournal of Pediatric Gastroenterology and Nutrition, 2005
- Do Corticosteroids Prevent Oesophageal Stricture After Corrosive Ingestion?Toxicological Reviews, 2005
- Corticothérapie à forte dose dans le traitement des œsophagites caustiques sévères chez l’enfantArchives de Pédiatrie, 2004
- Gravité des ingestions de produits caustiques chez l'enfantArchives de Pédiatrie, 1997
- Effects of Prednisolone and Dexamethasone in Children with Alkali Burns of the OesophagusEuropean Journal of Pediatric Surgery, 1996
- Steroids for the treatment of corrosive esophageal injury: A statistical analysis of past studiesThe American Journal of Emergency Medicine, 1992
- The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burnsGastrointestinal Endoscopy, 1991
- A Controlled Trial of Corticosteroids in Children with Corrosive Injury of the EsophagusThe New England Journal of Medicine, 1990
- Pathophysiology and management of acute corrosive burns of the esophagus: Results of treatment in 285 childrenJournal of Pediatric Surgery, 1971