We present the images from the upper endoscopy of a 5 year-old patient who developed an esophageal stricture from caustic ingestion. These images are from before and after a two-week course of topical budesonide. Her remarkable improvement suggests that we need more studies to investigate topical steroid use for caustic esophageal injury.
Caustic ingestion, Esophageal stricture, Steroids, Endoscopy
A 5 year-old patient presented with grade II esophageal injury due to an industrial strength bleach ingestion, which progressed to an esophageal stricture (Figure 1). Her initial treatment included standard of care with omeprazole and serial endoscopic dilations. Five weeks after her initial ingestion, the patient was placed on topical budesonide due to persistent dysphagia and weight loss. Two weeks later, repeat endoscopy visualized the esophageal stricture. There was marked improvement in the stricture diameter and evidence of mucosal healing (Figure 2). Clinically, her dysphagia resolved and she gained weight. Several weeks later, a repeat esophagram showed radiographic resolution of the stricture (Figure 3).
Caustic ingestions are a significant cause of morbidity and mortality in the pediatric population. Risk of esophageal stricture with Grade II injury is reported to be as high as 77% .
In pediatric eosinophilic esophagitis, topical steroids are used safely to treat inflammation and to prevent stricturing [7-8]. However, there remains a paucity of literature describing the use of topical steroids for esophageal stricture after caustic ingestion.
While we cannot make a definitive statement as to the cause of this patient's remarkable recovery, this case highlights the need for studies on the role of topical steroids in treatment of caustic esophageal injury.
1. Marisa Gallant- Reviewed case, prepared draft
2. Sabina Mir- Patient management with topical budesonide and endoscopic dilatation, revised draft and gave final approval for publication
3. Steven Lichtman- Initial management of patient, revised draft and gave final approval for publication
Figure 1: EGD after caustic ingestion.
Figure 2: EGD after topical budesonide.
Figure 3: UGI after topical budesonide.