Treatment of esophageal caustic injuries: experience with high-dose dexamethasone

Abstract

Caustic ingestion is one of the most life-threatening events in the pediatric age group. Several types of non-surgical management have been proposed for the esophageal strictures that inevitably follow ingestion. These include esophageal stenting and steroid therapy, which has received much attention in recent years. In this study, high-dose dexamethasone (1 mg/kg daily for 4–6 weeks) was administered to 9 children with endoscopic evidence of lesions equal to or greater than extended second degree who were at high risk of developing esophageal stenosis. Results were compared with those of other groups of children treated with the current protocol of 2 mg/kg daily oral prednisone. Clinical findings demonstrated that dexamethasone exerts a more effective anti-inflammatory action along with reduced cushingoid side effects; this enables children to better tolerate repeated dilatations, which often are necessary to maintain esophageal patency. However, since these treatment protocols were applied mainly to ammonia ingestions, which are known to induce less severe sequelae, further investigations are required in the presence of more serious initial lesions.