Epidemiological and clinical characteristics of pediatric corrosive ingestion and factors associated with acute esophageal injury: a single-center retrospective study.

BACKGROUND

This study aimed to investigate the epidemiology and clinical characteristics of accidental corrosive agent ingestion in children and to identify factors associated with the severity of acute corrosive esophageal injury.

METHODS

We retrospectively analyzed demographic and clinical data of 138 children who accidentally ingested corrosive agents in a single center from July 2014 to October 2024. The severity of esophageal injury was assessed using the Zargar grading system (Grade 0-IV) during initial endoscopy. Univariate analysis and multivariate logistic regression were used to identify factors associated with acute esophageal injury.

RESULTS

The median age of the 138 children was 2.08 years (interquartile range: 1.54-3.27). Children aged ≤5 years accounted for 87.68% (121/138), with a male-to-female ratio of 2:1. Alkaline agents accounted for 75.36% (104/138), with pipe cleaners being the most common source (28.99%). Gastrointestinal symptoms were the most frequent presentation (42.03%), followed by oral symptoms (29.71%), while 28.26% were asymptomatic. The median hospital stay was 2 days. Initial endoscopy showed normal mucosa (Grade 0) in 98 cases (71.01%) and abnormal findings (Grade I-IIIb) in 40 cases (28.99%). Proton pump inhibitors were used in 127 cases (92.03%), and corticosteroids in 48 cases (34.78%). Univariate analysis revealed significant correlations between abnormal Zargar grade and both age and time from ingestion to hospital presentation (both P < 0.05). Multivariate logistic regression further identified that age ≤5 years (odds ratio = 0.30, 95% confidence interval: 0.10-0.86, P = 0.025) and time to presentation ≤6 hours (odds ratio = 0.43, 95% confidence interval: 0.19-0.96, P = 0.038) were independent protective factors against abnormal endoscopic findings. Among the 17 patients who completed follow-up (12.32%), 9 (52.94%) developed dysphagia and 8 (47.06%) developed esophageal strictures; however, the low follow-up rate and selection bias limit the generalizability of these findings.

CONCLUSION

Age >5 years and time from ingestion to hospital presentation >6 hours are associated with an increased risk of acute esophageal injury in children following accidental corrosive ingestion (odds ratio = 3.33 and 2.33, respectively). Prompt medical evaluation and endoscopic assessment are recommended for children with suspected ingestion.