A comprehensive review of the pathophysiology and clinical management of caustic esophageal injury

Abstract Caustic ingestion is associated with substantial long-term morbidity and mortality. Complications range from acute perforation to progressive stricture formation, both of which impose a significant physical and financial burden on affected patients. The severity of gastrointestinal injury depends on several factors, including the type of substance ingested, its concentration, and the intent behind ingestion. Alkalis and acidic agents produce distinct patterns of tissue damage, causing liquefactive and coagulative necrosis, respectively. Pediatric exposures are typically accidental, whereas adult cases are more often intentional and associated with greater morbidity and mortality. In patients with suspected severe injury, early imaging with contrast-enhanced computed tomography has improved risk stratification and surgical decision-making. Endoscopy plays an essential role in initial evaluation in the first 24 h, while endoscopic dilation remains central to the management of chronic esophageal strictures. In highly selected or refractory cases, adjunctive therapies such as targeted corticosteroids or topical mitomycin C may be considered, though their routine use is not recommended. Long-term complications, including strictures, dysmotility, and malignancy, require ongoing surveillance. Preventive strategies, such as improved regulation of corrosive products and increased public awareness, are essential, particularly in high-risk populations. This narrative review summarizes the evolving diagnostic and therapeutic landscape of caustic esophageal injury and emphasizes a stratified approach to both acute management and chronic sequelae.