A new perspective of the risk of caustic substance ingestion: the outcomes of 468 patients in one North Taiwan medical center within 20 years

Abstract

Introduction

Caustic substance ingestion is frequently life-threatening, and its pathological mechanisms of tissue damage are well documented. However, few studies have assessed the combined effects of pH and the ingested dose on patient outcomes. Additionally, the miscellaneous chemical properties are not immediately available for providing predictive insights to physicians. This study aimed to provide a new perspective of the risk assessment of caustic substance ingestion based on the pH and dose.

Methods

The retrospective study analyzed adults treated for caustic substance ingestion at Chang Gung Memorial Hospital between January 1999 and December 2018. Uniformly strict inclusion/exclusion criteria and a double-checked process during chart review were adopted. All patients underwent urgent esophagogastroduodenoscopy (EGD) within 24 h. Caustic mucosal damage was graded using Zargar’s modified endoscopic classification. The pH and ingested dose of caustic substances were clearly recorded. Statistical analyses were conducted using IBM SPSS, version 22.

Results

Based on the 468 enrolled cases, the pH and dose were valuable predictors of the extent of gastrointestinal tract injury, commonly encountered complications, and long-term overall survival outcomes. Risks of mortality and perforation were dose-dependent for acids and pH-dependent for alkalis. The severe EGD findings (grade ≥ 2b) in this study were pH-dependent for both substances and additionally dose-dependent for acids.

Conclusion

Combining pH and dose, we proposed a new perspective for the risk assessment of caustic substance ingestion. Such findings may provide predictive insights for resolving clinical uncertainty before the availability of examination results. “Large doses of acids” and “high pH of alkalis” deserve special attention. This new perspective with a retrospective nature requires further validation.

Keywords:

• Caustic
• corrosive
• risk
• pH
• dose

Acknowledgments

Thanks for all the colleagues from the Department of Gastroenterology and Hepatology, Department of Psychiatry, Department of Emergency Medicine, Department of Medical Image and Intervention, Division of Trauma and Emergent Surgery, and Division of General Surgery of Linkou Chang Gung Memorial Hospital to help us caring the patients.

Author contributions

Study concept and design by Yu-Jhou Chen, Chen-June Seak, Shih-Ching Kang, and Hao-Tsai Cheng. Acquisition of data by all authors. Analysis and interpretation of data by all authors. Drafting the manuscript by Yu-Jhou Chen, Chen-June Seak, and Hao-Tsai Cheng. Critical revision of the manuscript for important intellectual content by all authors. Study supervision by Tsung-Hsing Chen, Chien-Cheng Chen, Chip-Jin Ng, Chao-Wei Lee, Ming-Yao Su, Hsin-Chih Huang, Pin-Cheng Chen, Chun-Hsiang Ooyang, Sen-Yung Hsieh, and Hao-Tsai Cheng.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical approval

Our research protocol had been approved by Chang Gung Medical Foundation Institutional Review Board (IRB number: 202000583B0; executing institution: Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan). The IRB reviewed and determined that it is expedited review according to personal information, data, documents, or specimens collected from legal biological databases without hyperlink or identifiable information can be used for research, but cannot be involved in the interests of individuals or groups. On the basis of aforementioned statements, the IRB approves the waiver of the participants’ consent in the present study.

Additional information

Funding

The study was supported by a grant from Linkou Chang Gung Memorial Hospital Research Project (Grant CMRPG3F1931) granted to Dr. Hao-Tsai Cheng. The funding source had no role in the study’s design, conduct, or reporting. The contents do not represent the views of Linkou Chang Gung Memorial Hospital.