Does steroid treatment prevent caustic esophageal stricture? A prospective study

Abstract

Purpose: It is controversial whether steroid therapy decreases the incidence of stricture formation in the esophagus following the ingestion of caustic substances. Methods: To evaluate this controversy, we designed a prospective controlled randomized clinical study. From September 1989 to February 1998, 161 consecutive patients with a history of caustic ingestion were admitted to our clinic. Early diagnostic esophagoscopy was done in all patients within 48 hours of ingestion. Of the 161 patients, 60 were excluded from the study due to the absence of esophageal injury. The children with varying degrees of acid and alkaline burns were randomly divided into steroid and non-steroid groups. The patients distributed into steroid group received methylprednisolone 3 mg/kg/d. A radiographic examination was done six weeks after caustic ingestion to evaluate early stricture formation. Results: Esophageal strictures developed in nine of the 50 children treated with steroids and in nine of the 51 controls. All strictures were encountered in patients with third-degree esophageal burn. Alkaline caustic agents caused a higher incidence of esophageal strictures than acid (P0.05) nor among the patients with alkali burn (p>0.05). Conclusion: The administration of steroid is found to be unnecessary to prevent the stricture formation secondary to caustic esophageal injury.