Complications Of Bleach Ingestion

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EGD after bleach ingestion
EGD after bleach ingestion

Ingestion of bleach led to esophageal stricture in a 5-year-old girl. She was treated with topical budesonide.

A 5 year-girl presented to the emergency department with grade II esophageal injury after industrial-strength bleach ingestion. Eventually, the esophageal injury progressed to stricture. Grade II esophageal injury have a 77% risk of progressing to esophageal stricture.

Initially, the treating physicians provided her standard treatment with omeprazole and serial endoscopic dilations.

Till five weeks after bleach ingestion, the patient had persistent dysphagia and she had lost considerable weight. The doctors started her on topical budesonide. It is a steroid. Studies have shown positive effects of budesonide in preventing esophageal stricture and in treating esophageal injury. However, some studies have suggested otherwise too, so the role of corticosteroids is still controversial.

 Two weeks later, repeat endoscopy identified an esophageal stricture. However, it showed marked improvement in the stricture’s diameter. Moreover, it also revealed mucosal healing.

The patient had shown clinical improvement. Her dysphagia resolved. She also gained weight.

After another few weeks, a repeat esophagram showed radiographic resolution of the stricture.

UGI after treatment with budesonide after bleach ingestion

Although with the treatment, the patient showed substantial improvement, it is still no safe to conclusively state the role of corticosteroids. Despite the insufficient evidence, for managing eosinophilic esophagitis (EoE), topical corticosteroids (as inhalers or as oral solutions) are the first-line treatment for preventing the strictures.

More studies are required to understand the role of budesonide and other steroids in the management of caustic esophageal injury.

References:

Gallant ML, Mir SA, Lichtman SN (2016) Treatment of Caustic Ingestion Associated Esophageal Stricture with Budesonide. Clin Med Img Lib 2:046. doi.org/10.23937/2474-3682/1510046

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Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

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