Caustic burns in the gastrointestinal tract and ingestion of foreign bodies

Ingestion of caustic agents and foreign bodies is a common problem of children aged 1-4 years. The cardinal symptoms are refusal to cat, salivation, agitation, and vomiting. The foreign bodies ingested are coins in more than 80% of cases. Urgent endoscopy is indicated when foreign bodies are sited at the upper esophageal sphincter, because of the risk of aspiration, and when a threat of perforation is perceived. Foreign bodies in the lower esophagus and disc batteries in the stomach should be monitored by X-ray at frequent intervals and must be removed if not progressing through the gastrointestinal tract. When objects known to be in the stomach are definitely nontoxic and mechanically harmless it is admissible initially to watch and wait. Caustic burns often lead to serious problems such as dysmotility, development of strictures, or even perforation. Endoscopic evaluation should be performed 6-24 h after such a burn is sustained. In the case of grade 11 or worse caustic burns it may be necessary to perform dilatation of any strictures. There is no consensus on the effect of steroids on the formation of scar tissue. Oral nutrition should be restarted once the patient is able to swallow; if necessary gastrostomy might be performed to make enteral feeding possible.