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CEsophagite caustique de l’enfant

Caustic esophagitis in children

Résumé

La prise en charge des enfants souffrant d’œsophagite caustique reste un sujet de discussion en raison du manque d’études prospectives. L’approche diagnostique et thérapeutique est fondée sur l’expérience clinique individuelle. L’analyse rétrospective de 73 dossiers d’enfants avec commémoratif d’ingestion de caustique a permis l’analyse des résultats de l’endoscopie du tractus digestif supérieur. Les lésions de degré IV s’observent uniquement après ingestion de silicates, de bases, d’acides organiques et d’acides. Les mesures thérapeutiques relatives aux sténoses œsophagiennes concernent uniquement les enfants qui ont absorbé des bases et des acides forts. L’ensemble de ces données impose de façon formelle l’endoscopie diagnostique chez un enfant présentant des symptômes cliniques et/ou une anamnèse d’ingestion de bases ou d’acides forts. Une endoscopie de contrôle est souhaitable après trois à quatre semaines. Les sténoses simples peuvent être traitées par dilatations; en revanche, les sténoses étendues ou multiples doivent bénéficier d’une œsophagectomie. Le rôle des stéroïdes au cours de la phase initiale n’est pas clairement établi; toutefois, l’antibiothérapie demeure essentielle.

Summary

Management of caustic esophagitis in children is still a matter of debate since prospective studies are missing. The diagnostic and therapeutic approach is based on individual clinical experience. In a retrospective analysis of 73 children with history of caustic ingestion the results of upper GI endoscopy were analysed. Grade IV lesions were only observed in patients with ingestion of silicates, lyes, organic acids and acids. Therapeutic measures because of esophageal stenosis were only necessary in children after ingestion of strong lyes and acids. From these findings we concluded that diagnostic endoscopy is mandatory in children with clinical symptoms and/or ingestion of strong lyes or acids. A second look endoscopy should be performed after 3–4 weeks. Simple strictures may be treated with dilatation manoeuvres, extended and multiple stenosis have to be treated by esophagectomy. The role of steroids in the initial phase is unclear, the therapy with antibiotics however is essential.

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Author information

Correspondence to M. Burdelski.

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Cite this article

Burdelski, M. CEsophagite caustique de l’enfant. Acta Endosc 24, 387–392 (1994). https://doi.org/10.1007/BF02970063

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Mots-clés

  • diagnostic
  • endoscopie thérapeutique
  • œsophagite caustique
  • sténose caustique

Key-words

  • caustic esophagitis
  • caustic stenosis
  • diagnosis
  • therapeutic endoscopy