Caustic ingestion in children: A prospective analysis of poor outcome key predictors useful for clinical management optimization

Abstract Objectives Endoscopic examination is the main diagnostic test to evaluate the extent and severity of any mucosal lesions after caustic ingestion, in order to target the most appropriate treatment and follow‐up. Our main aim was to evaluate clinical, biochemical, and instrumental parameters in order to identify possible key predictors of poor outcome and therefore identify possible subgroups of asymptomatic or paucisymptomatic children who may benefit from the endoscopic examination. Methods All children admitted for caustic ingestion were prospectively enrolled. Poor outcome was defined as the presence of mucosal lesions with severe/uncertain prognosis: Zargar score 2b to 4 or severe gastric/duodenal lesions. Results Two hundred and eighty‐three children were enrolled. No asymptomatic patient showed poor outcome ( p < 0.01). Children showing hematemesis, drooling, vomiting, oropharyngeal or labial lesions showed a higher risk of developing severe mucosal lesions ( p < 0.01). The ingestion of caustic substances inappropriately stored in plastic glasses or bottles was found to be a risk factor for unfavorable outcome ( p < 0.01). Conclusions Asymptomatic children should not undergo endoscopic examination since severe mucosal lesions are associated with the development of at least one sign or symptom. However, this recommendation may not apply to children under 18 months of age or those with delayed psychomotor development or neuropsychiatric pathologies, likely because they are unable to reliably report symptoms.

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Journal
Journal of Pediatric Gastroenterology and Nutrition
Published
2026-10-18
DOI
https://doi.org/10.1002/jpn3.70623
Primary Topic
Poisoning and overdose treatments
Type
article
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article

Caustic ingestion in children: A prospective analysis of poor outcome key predictors useful for clinical management optimization

Enrico Felici, Pasquale Dolce, Letizia Zenzeri, Monica Malamisura et al.
Journal of Pediatric Gastroenterology and Nutrition
Poisoning and overdose treatments
article

Caustic ingestion in children: A prospective analysis of poor outcome key predictors useful for clinical management optimization

Enrico Felici, Pasquale Dolce, Letizia Zenzeri, Monica Malamisura, Sara Renzo, Alessio Pini Prato, Luca Maria Antoniello, Barbara Parma, Renato Tambucci, Paolo Quitadamo, Valeria Dipasquale, Francesco Macchini, Margherita Rosa, Francesca Destro, Giovanni Di Nardo, Marta Maino, Piergiorgio Gragnaniello, Filippo Torroni, Andrea Chiaro, Rossella Turco
article en

Abstract

Abstract Objectives Endoscopic examination is the main diagnostic test to evaluate the extent and severity of any mucosal lesions after caustic ingestion, in order to target the most appropriate treatment and follow‐up. Our main aim was to evaluate clinical, biochemical, and instrumental parameters in order to identify possible key predictors of poor outcome and therefore identify possible subgroups of asymptomatic or paucisymptomatic children who may benefit from the endoscopic examination. Methods All children admitted for caustic ingestion were prospectively enrolled. Poor outcome was defined as the presence of mucosal lesions with severe/uncertain prognosis: Zargar score 2b to 4 or severe gastric/duodenal lesions. Results Two hundred and eighty‐three children were enrolled. No asymptomatic patient showed poor outcome ( p < 0.01). Children showing hematemesis, drooling, vomiting, oropharyngeal or labial lesions showed a higher risk of developing severe mucosal lesions ( p < 0.01). The ingestion of caustic substances inappropriately stored in plastic glasses or bottles was found to be a risk factor for unfavorable outcome ( p < 0.01). Conclusions Asymptomatic children should not undergo endoscopic examination since severe mucosal lesions are associated with the development of at least one sign or symptom. However, this recommendation may not apply to children under 18 months of age or those with delayed psychomotor development or neuropsychiatric pathologies, likely because they are unable to reliably report symptoms.

Journal of Pediatric Gastroenterology and Nutrition
University of Messina (IT), University of Padua (IT), Istituto Giannina Gaslini (IT), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), Azienda Ospedaliera San Gerardo (IT), Meyer Children's Hospital (IT), Bambino Gesù Children's Hospital (IT), Santobono Children's Hospital (IT), Azienda Ospedaliera Sant'Andrea (IT), Ospedali Riuniti San Giovanni di Dio e Ruggi d'Aragona (IT), Azienda Ospedaliera Universitaria Policlinico "G. Martino" (IT), Ospedale dei Bambini Vittore Buzzi (IT), Ospedale Sant'Anna (IT), Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo (IT), University of Naples Federico II (IT)
Openalex Percentile: Top 9%
Poisoning and overdose treatments
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