Sistema gastrointestinal y digestivo

Abstracto

Hypermetabolism Correlated with Subsequent Stricture Formation in Esophageal Caustic Burn Injury in Children

Yen Nan Ku, Shun Ching Chao, Ming Wei Lai, Man Shan Kong, Shih Yen Chen

Objective: Hypermetabolism is commonly found in esophageal caustic injury. Our aim was to assess metabolic conditions in children after esophageal caustic burn and to investigate their outcome prediction with treatment impact.

Design: Retrospective medical review study.

Setting: One tertiary academic center.

Patients: Children with caustic esophageal burn admitted to Chang Gung Children’s Hospital during 1993 to 2013 were enrolled and medically reviewed.

Interventions: None.

Measurements and Main Results: A score system based on clinical and metabolic condition with total 5 items and the highest score of 6 was designed and applied to predict esophageal stricture and medical assessment after corrosive injury. Using SAS system software version 8 for Windows, continuous and dichotomous variables were analyzed.

A total of 57 children were enrolled during the 20-year period. High-grade esophageal burn was diagnosed in 36 patients (63%). Fourteen (24.6%) of them subsequently developed esophageal stricture formation. Thirteen of the 14 patients (92.9%) manifested at least 1 of the hypermetabolic signs. Statistical analysis showed significant risk factors for stricture were hyperthermia (P= 0.011), hyperglycemia (P=0.001), and high grade burn injury (P=0.001). By our scoring system, the positive prediction of stricture formation was: 3 of 4 patients (75%) scored 6, 6 of 10 patients (60%) scored 5 or higher, 11 of 20 patients (55%) scored 4 or higher, 14 of 29 patients (48%) scored 3 or higher, and 14 of 43 patients (33%) scored 2 or higher. Ten of the 30 patients (33%) treated with antibiotics and 11 of the 34 patients (32 %) given steroids finally developed esophageal stricture.

Conclusions: Hypermetabolism is commonly found and correlated to subsequent esophageal stricture after caustic burn injury in children. The score system included metabolic factors provide an objective way for predict stricture formation. The application of corticosteroid should be carefully evaluated for its impact on hypermetabolism, risky for subsequent stricture formation.