Corrosive esophagitis
Corrosive esophagitis usually occurs from accidental or suicidal ingestion of caustic substances (e.g. lye, household cleaners, bleaches, washing soda), and is harmful to the esophagus due to their alkali medium. The stomach is not affected as the gastric acid can neutralize these substances, however, in cases of acidic corrosives, the esophagus can be spared while the stomach is severely injured.
The esophageal damage depends on the concentration, type, and quantity of ingestion of the harmful material and the time of contact between it and the esophagus. It usually affects the middle and lower third of the esophagus.
Clinical presentation
Dysphagia is the main clinical symptom .
Pathology
- acute stage: in the first 10 days from ingestion; acute necrosis with mucosal blurring and dilated atonic esophagus
- subacute stage: 10-20 days after ingestion and characterized by esophageal ulceration
- chronic stage: occurs after 21 days with esophageal inflammation healed by fibrosis resulting in stricture
Radiographic features
Fluoroscopy
Water-soluble contrast medium is preferred in the acute stage. Findings in acute stage include mucosal edema, ulceration and sloughing of the mucosa with esophageal dilatation and atony. Complications seen in this stage can include perforation and leakage; the same findings can be seen in the subacute stage with mild esophageal narrowing.
Barium contrast can be used in the chronic stage; there are single long or multiple strictures involving the middle and lower esophagus.
Complications
Esophageal perforation and increased incidence of squamous cell carcinoma of the affected segment.
Differential diagnosis
