Abstract. CASTANO LL, Rodrigo et al. Dilatación endoscópica y aplicación de esteroides intralesionales en las estenosis esofágicas por cáusticos y. Lesiones esofagogástricas por cáusticos. Esophageal-gastric .. ¿Produce la ingesta de cáusticos alteraciones motoras esofágicas irreversibles? Estudio manométrico .. Estenosis esofágica extensa secundaria a esofagitis Gastroenterol. Se estudiaron 60 pacientes menores de 15 años con estenosis esofágica, 40 de ellos por ingestión de cáusticos y 20 por otras causas.
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Lesiones esofagogástricas por cáusticos | Gastroenterología y Hepatología
Nutritional status in children with esophageal stenosis and dysphagia associated with caustic ingestion. Centro Universitario de Ciencias de la Salud. High Speciality Medical Unit. Instituto Mexicano del Seguro Social. Caustic ingestion CI in children and adolescents may lead to esophageal burns, esophageal stenosis and secondary dysphagia. These complications may limit the normal feeding process leading to malnutrition and growth impairment.
Our aim was to evaluate the nutritional status and its association with dysphagia and esophageal stenosis in children with CI.
Sixty-two patients with caustic ingestion treated at a pediatric referral hospital were included in this cross-sectional study.
The dependent variables were growth and nutritional status evaluated by anthropometry. The average age at the time of CI was Both complications occurred simultaneously in 20 children The z-score of height-for-age was below -2 SD in five children 8.
The z-score means of the arm anthropometric indicators of fat stores and muscle mass in both the dysphagia and esophageal stenosis groups were located in the negative area of the z-score curve and their values differed significantly from the z-scores of the non-dysphagia and non-stenosis groups.
The proportion of erosive esophagitis, esophageal stenosis and dysphagia was high. Caustic ingestion CI is an unfortunate event that children and adolescents may suffer when living in homes with a poor injury prevention culture Ingestion of acid or alkali substances frequently leads to upper gastrointestinal tract damage manifested in the short term as esophageal burns and later as esophageal stenosis.
It can also result in acquired motility disorders and secondary dysphagia These conditions may limit the normal feeding process leading to malnutrition and growth impairment, particularly in developing countries Data related to the nutritional status in children with caustic esophageal burns are scarce. Therefore, our aim was to evaluate the nutritional status and its association with dysphagia and esophageal stenosis in children with CI.
The period running from the time when the CI happened to inclusion in the study was longer than six months in all cases. The average age when the injury occurred was In this cross-sectional study the assigned independent variables were: The dependent variables were growth and nutritional status evaluated by anthropometrical indicators.
The complete X-ray and endoscopic charts had to be available for all patients included in the study. Children with genetic, chronic, or systemic diseases were not included. Swallowing data were obtained through a direct interview with the patients and their parents or guardians. Dysphagia was defined as difficulty swallowing solid or semi-solid foods that occurred after CI and was evaluated with the “Dysphagia Score” Data of the mucosal esophageal damage observed through endoscopy upon admission were classified according to Zargar’s classification Results were then expressed as a dichotomic variable: A barium swallow was performed 3 weeks after CI.
Diagnosis of esophageal stenosis was established in the presence of narrowing of the esophageal lumen and lack of normal esophageal distension during fluoroscopy. Before the data were collected, the main author and two collaborators performed an anthropometrical standardization trial with 30 children under 6 years of age.
Consistency intra-group individual measurements and validity inter-group comparison with a gold standard were evaluated with Pearson’s bivariate correlations; when the correlation coefficient was below 0. Study subjects were weighted without shoes and minimal clothing, using a movable weight platform-beam scale. Weight was recorded to the nearest grams 18, Height was measured and recorded to the nearest 0. The subjects were measured while standing, without shoes, heels together, back as straight as possible, and arms hanging freely.
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The head was positioned in the Frankfort horizontal plane and the movable block was brought down until touching the head 18, Mid esofagiica circumference MAC: MAC was calculated with the right arm bent at the elbow at a 90 o angle while the upper arm was held parallel to the side of the body. The distance between the acromion and the olecranon was measured with a fiberglass tape and the midpoint between these two spots was marked.
The patient’s right arm was hanging loosely and relaxed to the side of his or her body. A fiberglass metric tape was positioned at the marked midpoint and the circumference was recorded to the nearest 0. The TSF was measured with a Lange skinfold caliper at the previously marked midpoint on the posterior portion of the right upper arm with the arm extended in the same relaxed position held in MAC.
The examiner grasped a vertical pinch of skin and subcutaneous fat between the thumb and forefinger about 1 cm above the previously marked midpoint pulling away gently from the underlying muscle. The skinfold caliper was placed at the marked midpoint while keeping the skinfold grasped.
Readings were taken in millimeters as soon as the caliper came in contact with the skin and the dial reading stabilized. Babies sat on their mothers’ laps and children were measured standing up Total, muscle, and arm fat areas: Results were expressed in square millimeters.
Body mass index BMI: BMI was calculated as weight kg divided by height squared m 2. Reference patterns and indicators of nutritional status: Kappa test was used to determine concordance between esophageal stenosis and dysphagia.
Informed consent was obtained from the parents or guardians. The study protocol was approved by the Hospital Research and Ethics Committee Endoscopy performed upon admission revealed that four children 6. No cases of esophageal perforation Zargar IV were found.
Dysphagia with solid or semi-solid foods occurred two to three weeks after the CI in 24 Barium swallows revealed esophageal stenosis in 40 cases The odds ratio of having dysphagia in the presence of stenosis was 4.
Esophageal strictures and dysphagia occurred simultaneously in Most of the stenoses were located in the mid esophagus; in four cases 6. Overall, height-for-age was located in the negative area of the z-score curve in 41 cases The mean z-score in the 40 cases with stenosis was The mean z-score in 24 children with dysphagia was Overweight plus obesity z-score above 1 SD was identified in 30 children The mean z-scores of the arm anthropometric indicators were compared according to the presence or absence of dysphagia or esophageal stenosis Table II.
Arm indicators of the children with both dysphagia and esophageal stenosis were all located in the negative area of the z-score curve.
In all cases, z-score values were significantly lower in the children with dysphagia or stenosis when compared with the cases without these complications. The clinical impact of a single event of CI is underlined in the current study: The observation that one-half of the patients with stenosis did not complain of dysphagia and that some patients with dysphagia had no esophageal stenosis points to the underlying complexity of the functional and anatomical esophageal damage induced by the chemical agent, as well as to the individual variation in visceral sensitivity.
Given the severity of the esophageal damage that usually occurs in children with CI, it is surprising that there is very little published information regarding their nutritional status. In France, Ganga-Zandzou et al.
These findings may be interpreted as loss of fat stores and may be considered as impaired esofgaica status The arm muscle area showed significant differences in the same direction as the fat stores, but this was observed only in the children with dysphagia. The clinical significance of these findings should be weighed within the framework of a symptom dysphagia and an anatomical abnormality stenosiswhich may have a chronic outcome and in many cases will not be entirely resolved.
If the changes in body composition persist for years, they could possibly result in a more severe impairment in fat stores, muscle mass and eventually in linear growth. In the current series we found a low proportion of height-for-age below -2 SD, which is comparable to its prevalence in the National Health and Nutritional Survey performed in Mexico 24and it may reflect a population prevalence rather than an effect of the CI.
However, in most cases, anthropometric indicators related to fat stores and muscle mass of children with dysphagia or stenosis were significantly lower than those of the children without these complications. Unfortunately, we could not compare these results with the National Health and Nutritional Survey performed in Mexico to determine whether the nutrition rates found in esifagica population with stenosis or dysphagia due to CI represented a population subset or a true diseased population, since the survey did not include arm anthropometry in the population studied.
Moderate or severe secondary malnutrition is frequently associated with gastrointestinal diseases affecting the liver, the pancreas and the small intestine, all of which share impaired digestion and absorption mechanisms. In contrast, the main function of the esophagus is to transport the food contents from the mouth to the stomach, without any digestive or absorptive functions 25which may account for the low frequency of malnutrition found in our series. However, besides the anatomical evidence of esophageal narrowing, children may have esophageal dysmotility.
Esophageal manometry has revealed hypoperistalsis, with normal upper and lower esophageal sphincter, in children with CI 26, Transit time was estenoss prolonged in patients with lower third esophageal scars 6. Gastric emptying time assessed by radionuclide scintigraphy after a CI event was significantly prolonged in patients with esophageal stenosis, even in the absence of gastric symptoms Another study reported that esophageal transit time, assessed by scintigraphy, was prolonged in one-third of patients with corrosive-induced esophageal stenosis, despite having achieved adequate dilatation.
They found that the prolongation of esophageal transit time correlated with the length of the stricture and that the severity of dysphagia dausticos with the prolongation of total esophageal transit time A retrospective analysis of ingestion of caustic substances by children.
Estenoosis statistics in Galicia. Eur J Pediatr ; Pan Afr Med J ; A different aspect of corrosive ingestion in children: Int J Pediatr Otorhinolaryngol ; Oesophageal corrosive injuries in children: Bull World Health Organ ; J Pediatr Surg ;