Comparative Analysis of Accidental and Intentional Caustic Ingestion: Clinical Presentations, Endoscopic Findings, and Outcomes

Introduction: Caustic ingestion poses a significant global health burden and is primarily categorized as accidental or intentional. Despite increased awareness and preventive measures, it continues to result in substantial morbidity encompassing diverse demographic and clinical presentations. Methods: This retrospective study aimed to compare the demographics, clinical presentation, endoscopic findings, and outcomes of accidental and intentional caustic ingestion. We reviewed the medical records of 99 adults (aged >18 years) who had caustic ingestion. Patients with upper gastrointestinal malignancy, esophageal stricture, or thoracic radiation were excluded. Demographic, clinical, and endoscopic data were assessed using the Zargar classification, and comparisons were made between the accidental and intentional ingestion groups regarding the presenting symptoms, injury severity, and long-term complications. Results: A total of 99 cases were included, with 69 (69.7%) cases of accidental ingestion and 30 (30.3%) of intentional ingestion. Accidental ingestion was more prevalent among young South Asian male cleaners, whereas intentional ingestion was more common among females with psychiatric conditions. Alkaline substances were the most frequently ingested agents in both groups, with the majority of patients consuming less than 100 mL. Esophagogastroduodenoscopy, performed in 90.9% of cases, predominantly revealed Zargar grade 0 and 1 injuries, with no significant differences in injury severity between the groups. Conclusion: The study found no significant differences in clinical and endoscopic outcomes between accidental and intentional ingestion cases. Future research should focus on refining management strategies, particularly for asymptomatic cases, and exploring targeted prevention programs to mitigate occupational and psychiatric risks associated with caustic ingestion.