Predictive Factors of Gastrointestinal Caustic Injury According to Clinical and Endoscopic Findings

Background: Ingestion of caustic substances is the main reason for referral to Philippines National Poison Management and Control Center among other causes of acute poisoning. Rapid assessment of severity of injury is important for treatment and prognosis of these cases. This study was aimed to investigate the correlation of clinical factors with severity of gastrointestinal (GI) mucosal injury. Methods: In this retrospective study, a total of 105 patients were included. Patients were categorized into two groups including 35 patients with low grade and 70 patients with high grade GI injury to compare the predictive value of clinical findings. Results: Mean (SD) age of patients was 27 (10) and 47% of patients were male. Oral burns (P<0.001), dysphagia (P=0.001), hematemesis (P<0.001), number of presenting symptoms (P=0.001), and type of substance consumed (P<0.001) were significantly different between patients with high grade and low grade GI injuries. Multivariate analysis showed that only leukocytosis was a significant predictor of higher grades of GI injury (OR=17.3, P=0.004). Nevertheless, dysphagia (OR=8.1), and higher number of manifestations (OR=2.8) on initial evaluation could be considered as weak factors as they did not reach significance (P=0.09). Conclusion: Following caustic substance injury, prompt assessment of severity of GI injury according to endoscopic and physical examinations can facilitate better treatment plan and prognosis. Patients with leukocytosis should be more carefully monitored as they might be injured with higher grades of GI mucosal lesions.

Keywords:

Caustic substance ingestion , Endoscopy , Predictive factor , Poisoning , Gastrointestinal injury