High doses of methylprednisolone in the management of caustic esophageal burns

Pediatrics. 2014 Jun;133(6):E1518-24. doi: 10.1542/peds.2013-3331.

Abstract

Objective: Caustic substance ingestion in childhood is a public health issue in developing countries, and several management protocols have been proposed to prevent the resulting esophageal strictures. The role of corticosteroids in preventing corrosive-induced strictures is controversial. Our aim was to study the influence of high doses of corticosteroids in preventing esophageal strictures.

Methods: Eighty-three children with a mean age of 4.10 6 2.63 years and with grade IIb esophageal burns (an esophagogastroscopy was performed within 24–48 hours of injury) due to corrosive substance ingestion were enrolled in our study between 2005 and 2008. Forty-two children (study group) received methylprednisolone (1 g/1.73 m2 per day for 3 days), ranitidine, ceftriaxone, and total parenteral nutrition. Forty-one children (control group) were administered the same regimen excluding methylprednisolone. Stricture development was compared between groups based on endoscopic and radiologic findings.

Results: During the endoscopic examination, stricture development was observed in 4 patients (10.8%) in the study group and in 12 patients (30%) in the control group. The difference was statistically significant (P = .038). The stricture development rate in the upper gastrointestinal system with barium meal was 14.3% and 45.0% in the study and control groups, respectively. The difference was statistically significant (P = .004). The duration of total parenteral nutrition was shorter in the study group compared with the control group (P = .001). High doses of methylprednisolone were well tolerated in the study group without any side effects.

Conclusions: High doses of methylprednisolone used for the management of grade IIb esophageal burns may reduce stricture development.

Trial registration: ClinicalTrials.gov NCT02002078.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Burns, Chemical / classification
  • Burns, Chemical / complications
  • Burns, Chemical / drug therapy*
  • Caustics / toxicity*
  • Ceftriaxone / administration & dosage
  • Child
  • Child, Preschool
  • Combined Modality Therapy
  • Dose-Response Relationship, Drug
  • Esophageal Stenosis / chemically induced*
  • Esophageal Stenosis / prevention & control*
  • Esophagoscopy
  • Esophagus / drug effects*
  • Esophagus / injuries*
  • Female
  • Humans
  • Infusions, Intravenous
  • Male
  • Methylprednisolone / administration & dosage*
  • Parenteral Nutrition, Total
  • Prognosis
  • Ranitidine / administration & dosage
  • Turkey

Substances

  • Caustics
  • Ceftriaxone
  • Ranitidine
  • Methylprednisolone

Associated data

  • ClinicalTrials.gov/NCT02002078