Burn of the esophagus. Causes, symptoms and treatment of esophageal burn

Damage to the oral mucosa, walls of the esophagus and stomach is caused by exposure to aggressive reagents and high temperature. If adults are capable of causing harm to themselves deliberately - when attempting suicide, then children most often suffer due to the negligence of adults.

Destructive effects of poisons

It is the adults who are to blame, not the children, for the free access of chemicals or for the occurrence of thermal burns. Small children themselves do not know how to compare the steam above a cup or plate with the temperature of the dish, and their knowledge of the world is instinctive.

Children experience the world with the help of all their senses, and the sense of taste takes almost the first place among them.

Burns in children occur if they taste household chemicals, food vinegar, alcohol, medicinal solutions, or hot drinks.

When a child’s esophagus is burned, the mucous membrane of the oral cavity and nasopharynx is injured; the aggressive component or hot liquid also penetrates the stomach, causing a destructive effect.

The sooner first aid is provided, the greater the chance that the dangerous injury will not cause serious consequences in the baby’s later life.

Classification of burns and symptoms when they appear

Esophageal burns are classified into 3 degrees:

1 lung – desquamative esophagitis. Swelling of the mucous membrane and hyperemia appear. The epithelium is restored within a week, no consequences - scarring or narrowing of the esophagus - appear.

2nd degree – along with the mucous layer, the submucosal layer is also affected. The resulting ulcers are filled with fibrin, which is separated by the end of 2 weeks after the injury; by the 21st day, epithelization begins; if scars are formed, the condition does not affect the process of swallowing and digestion.

Grade 3 - all layers of the esophagus are affected, granulation of ulcers begins 3-4 weeks after injury. Connective tissue appears at 5 weeks, and scarring begins at 6-8 weeks. A narrowing of the esophagus may occur. The defeat is extremely difficult.

You can understand that a child has an injury to the oral cavity and esophagus by the following symptoms.

Local manifestations:

ulcerations of the lips and mouth;
the appearance of plaque on hyperemic areas;
shortness of breath or suffocation;
vomit;
feeling of thirst;
hoarseness of voice.

Common symptoms that doctors immediately see:

intoxication of the body;
shock or collapse;
lack of coordination;
reflex dysfunction.

Hepatic-renal failure may occur as a complication.

The severity of the condition is influenced by the amount of the substance taken and the degree of its concentration.

The child may indicate pain in the area not only of the mouth, but also of the neck, sternum, back - in the projection of the epigastrium. If acute swelling of the larynx occurs, it will be impossible to provide first aid.

First aid for burns of the esophagus in children

Of course, for a child who has received a burn, it is necessary to immediately call an ambulance. Regardless of the severity of the condition, treatment is carried out in a hospital.

Only in a hospital setting is it possible to eliminate the consequences of burn shock - without infusion therapy this cannot be done. At home, even the medical team only provides pain relief.

Hospitalization is carried out in the therapeutic department - surgical intervention is necessary only if perforation or profuse bleeding occurs. Narrowing of the esophagus, a complication after a burn, is tried to be treated with conservative methods.

At home, the child needs to provide first aid - try to rinse the esophagus and oral cavity, trying to wash off the aggressive agent. Washing is carried out with milk, warm water, sunflower oil dissolved in water.

When providing first aid for a chemical burn of the esophagus, they try to neutralize the aggressive component:

If alkali enters the body, lemon juice, sunflower oil, vinegar are added to the water for gastric lavage - 1 tablespoon of 9% vinegar is added per liter of water;
If a child swallows a saturated solution of potassium permanganate, it is neutralized with ascorbic acid - 1 part ascorbic acid and 99 parts water; lemon juice dissolved in warm water;
An acid burn is neutralized with an alkaline solution - half a teaspoon of baking soda is dissolved in 1 liter of boiled water.

You can make a universal antidote that at home will help neutralize the aggressive component of any chemical burn - combine warm milk with boiled water in equal quantities in a glass, adding beaten egg white to the drink.

There is no need to be afraid that the child immediately vomits after taking a detoxifier - this is very good, the body is cleansed of harmful substances.

If a burn to the esophagus is caused by food or alcohol, it is recommended that children be given cool milk or a few tablespoons of any vegetable oil.

Treatment for burns of the esophagus in children

First aid after burns is provided to children at home; further treatment is carried out in a hospital setting, even if the injury is minor. If there is an inflammatory process in the oral cavity, the child cannot eat for a week - this is very dangerous. Children quickly become dehydrated and lose weight.

Life support is necessary not only for chemical burns, but also for thermal and alcohol burns.

The degree of damage to the esophagus is finally determined from 2 to 10 days after the injury - only then does it become possible to carry out the FGS procedure. It is performed with a special pediatric endoscope or bronchoscope; during it, changes and the boundaries of the distribution of affected tissues are identified.

The procedure is not performed in the presence of perforations, sepsis, symptoms of shock, or the presence of cardiovascular pathologies.

After intensive therapy to eliminate the state of shock and intoxication, antibiotics are prescribed to exclude the possibility of infection, hormonal drugs are prescribed - they accelerate regenerative processes in damaged tissues, and oxygen therapy is carried out.

For second-degree burns, children require parenteral nutrition to prevent dehydration and receive infusion therapy. Medicines are also administered by injection, in droppers or injections.

On days 2-8 after injury, with degree 2-3 damage, complications may occur - narrowing of the esophagus, manifestations of hepatic-renal failure.

Expansion of the lumen of the esophagus is performed no earlier than 7 days after the burn - probes of different diameters are sequentially inserted into the esophagus, which gradually expand its lumen.

After a burn of the esophagus, children may develop the following complications within a month:

the appearance of atypical cells;
development of a malignant tumor - carcinoma;
the occurrence of gastroreflux disease;
narrowing of the esophagus;
swallowing dysfunction;
violation of the motor function of the esophagus.

If parents notice problems with swallowing function, or if the baby, who was discharged in a stable condition, constantly vomits while eating, it is necessary to consult a doctor.

Contents of the article

Chemical burns of the esophagus- development of the inflammatory process in the esophagus under the influence of irritating chemicals.

Prevalence of chemical burns of the esophagus

Burns of the esophagus are more common in children aged 1 to 3 years, combined with burns of the oral cavity and respiratory tract.

Pathogenesis of chemical burns of the esophagus

The severity of a burn to the esophagus and the degree of pathological and morphological changes depend on the amount and composition of the chemical substance. When exposed to acids, the depth of damage to the wall of the esophagus is less (crust formation) than when exposed to alkalis. The effect of alkalis on tissue is accompanied by liquefaction necrosis, and the absence of a scab leads to deep penetration of the caustic substance and tissue damage.

Classification of chemical burns of the esophagus

There are 3 degrees of esophageal burn:
1st degree (mild) - desquamative esophagitis. Hyperemia and swelling of the mucous membrane are detected. Within 7 days, acute inflammatory phenomena subside, the epithelium is restored, scars and contractions do not occur.
2nd degree (moderate) - damage to the mucosa and submucosal layer. Starting from the second week, ulcers and erosions are cleared of fibrin, epithelization occurs by the end of the third week, and no rough scars occur.
Grade 3 (severe) is characterized by damage to all layers of the esophagus. From the third week, the ulcers are filled with granulations, which are replaced by connective tissue from the 4-5th week. Scars take 6-8 weeks to form.

Clinic for chemical burns of the esophagus

In the first hours of burns, there is anxiety, reflex vomiting, difficulty swallowing, increased salivation, after which the scarring stage begins, which is clinically expressed in a deterioration in the passage of first thick and then liquid food. The result is complete cicatricial obstruction of the esophagus.

Diagnosis of chemical burns of the esophagus

Fibroesophagoscopy should be performed 3-4 days after the burn, which will allow determining the size of the burn. Hyperemia and swelling of the esophageal mucosa are characteristic of the first stage of care. After about a week after the burn, it is possible to distinguish the second stage from the third. Currently, in the second degree, epithelization occurs, in the third, granulating ulcerative burn surfaces appear.

Treatment of chemical burns of the esophagus

Treatment of children begins immediately after a burn and consists of anti-shock therapy, along with local treatment. First aid is provided at the scene of the incident and consists of rinsing the mouth by drinking plenty of water, milk, rinsing the stomach through a tube, prescribing inhalations, antibacterial therapy, hormones, painkillers and sedatives are required. Monitoring of CBS and blood gases and their correction, infusion therapy under the control of diuresis. Children with first-degree burns do not require treatment. For the second and third stages of burns, the main method of preventing narrowing of the esophagus is early bougienage with elastic bougies, which should be carried out 6-8 days from the onset of the disease.

– damage to the tissues of the esophagus resulting from direct exposure to aggressive chemical, thermal or radiation agents. The first signs of a burn are severe burning pain in the mouth, behind the sternum, in the epigastrium; hypersalivation, vomiting, swelling of the lips. In the future, the clinical picture of intoxication, shock, and esophageal obstruction predominates. In diagnosis, the anamnesis of the disease is of leading importance; after exiting the acute phase, esophagogastroscopy and radiography of the esophagus are performed. Emergency therapy consists of neutralizing the chemical agent, pain relief, anti-shock and detoxification measures. In the scarring stage, surgical treatment is performed.

General information

An esophageal burn is a severe injury to the walls of the esophagus, most often associated with accidental or special ingestion of aggressive liquids. Approximately 70% of patients with burn injuries to the esophagus are children. Ingestion of caustic alkalis and acids by children occurs mostly unintentionally - due to the habit of trying everything, by mistake, or when aggressive chemical solutions are improperly stored (in containers for drinks and food products). In adults, burns to the esophagus in 55% of cases occur due to accidental intake of acids and alkalis instead of drinks or medicine (domestic injury) and in 45% - for the purpose of suicide. The vast majority of esophageal burns are caused by chemicals; radiation and thermal injuries are extremely rare. In previous years, the most significant cause of chemical burns was the ingestion of solutions of caustic soda or potassium permanganate. Today, 70% of burn injuries to the esophagus are caused by vinegar essence.

Causes of esophageal burn

The most common type of esophageal injury is chemical burns. A burn of the esophagus can be caused by concentrated acid (acetic, hydrochloric, sulfuric), alkali (caustic soda, caustic soda, sodium hydroxide), other substances (ethyl, phenol, iodine, ammonia, Lysol, silicate glue, acetone, potassium permanganate, electrolyte solutions, peroxide hydrogen, etc.). The reasons for taking aggressive chemicals can be very diverse.

The vast majority of patients with esophageal burns are children from one to ten years of age. The increased incidence of injuries among children in this age range is explained by their natural curiosity and absent-mindedness. Parental carelessness in everyday life is also of great importance when caustic substances are stored in unmarked containers or drink containers. Among adults, chemical damage to the esophagus in approximately half of the cases can be caused by accident (taking alcohol substitutes, caustic substances while intoxicated or due to inattention), the remaining cases are usually associated with a suicide attempt. Taking aggressive solutions for suicidal purposes is more common among women. Thermal and radiation burns of the esophagus are extremely rare.

Caustic substances, when they come into contact with the mucous membrane of the oral cavity, pharynx, esophagus and stomach, cause damage to the epithelium, and as the process progresses, to deeper tissues. Typically, acids cause a more severe burn of the esophagus, and alkalis cause a more severe burn of the stomach. This is due to the resistance of the gastric mucosa to an acidic environment. Burns of the esophagus with alkalis are characterized by a more severe course and deep damage; such burns are often accompanied by rupture of the esophagus, mediastinitis, purulent complications, and gastric bleeding.

Based on the depth of spread of the pathological process, burns of the esophagus are distinguished as first degree (affects only the epithelium), second degree (affects the muscle layer inclusive) and third degree (pathological changes cover the tissue surrounding the esophagus and neighboring organs). The deeper the burn of the esophagus spreads, the more toxic products of tissue breakdown enter the blood. Severe intoxication can lead to damage to the heart, brain, kidneys and liver. The combination of painful shock, intoxication and multiple organ failure in deep burns of the esophagus leads to death in the first two to three days.

Symptoms of a burn to the esophagus

With a burn of the esophagus, both local and general symptoms are disturbing. The aggressive solution, when it gets on the epithelium of the esophagus, causes significant damage to tissues and nerve endings, of which there are a huge number in the esophagus. Because of this, severe pain occurs as the burn spreads: in the mouth, throat, behind the sternum and in the epigastrium (the damaging agent enters from the esophagus into the stomach, causing chemical gastritis). Severe tissue damage (corrosive esophagitis) leads to swelling: first the lips and tongue begin to swell, then the process spreads to the pharynx and esophagus. Swelling of the larynx causes shortness of breath, and damage to the vocal cords leads to hoarseness. In the esophagus, the greatest pathological changes are formed in places of physiological narrowing. First, this leads to dysphagia (impaired swallowing), followed by vomiting. Blood clots and fragments of the mucous membrane of the digestive tube can be seen in the vomit. A 3rd degree burn of the esophagus can lead to severe breathing problems, profuse bleeding, and the formation of esophageal-bronchial fistulas.

General signs of a burn of the esophagus are caused by the absorption of toxic products of tissue breakdown and pain. Deep burns are accompanied by massive tissue necrosis and severe intoxication and painful shock. The breakdown products damage the cells of the heart, brain, kidneys and liver. Multiple organ failure and intoxication are manifested by severe weakness, nausea, fever, disturbances of consciousness and cardiac activity. The severity of the general manifestations depends on which chemical substance was drunk, its volume and concentration.

If the patient’s condition stabilizes, then a few days after receiving a burn to the esophagus, the swelling decreases, and tissue healing begins through granulation and scarring. At the beginning of the disease (acute period), due to pain and swelling, patients refuse food and water. Along with the appearance of granulations, a subacute period begins, in which the so-called “false remission” occurs - the fear of eating gradually goes away, swallowing becomes easier. However, the phenomena of dysphagia return again due to the appearance of cicatricial strictures in the chronic period of a burn of the esophagus. According to clinical studies in the field of gastroenterology, cicatricial strictures of varying degrees form in all patients with a burn of the esophagus within two months of the onset of the disease. This process is accompanied by progressive dysphagia, hypersalivation, vomiting, and nutritional dystrophy. If correction of burn scars is not carried out promptly and properly, persistent scars with stenosis or obstruction of the esophagus develop in 70% of patients.

Diagnosis of esophageal burn

The diagnosis of a burn of the esophagus is usually established before additional research is carried out, based on the medical history. Consultation with a gastroenterologist and surgeon is necessary to determine the mechanism of the burn; type (acid or alkali), quantity and concentration of the chemical agent. Considering the severity of damage to the esophagus during a burn and the danger of perforation of its wall, invasive diagnostic techniques are not used in the first three days after injury.

After stabilization of the general condition, radiography of the esophagus is possible. In the acute phase of the burn, the x-ray shows thickening of the folds of the mucous membrane, indicating hyperkinesia of the esophagus. Consultation with an endoscopist in the acute period is more informative: during esophagogastroscopy, hyperemia and swelling of the epithelium, ulceration and erosion of the esophagus, and plaque are visualized. In the subacute phase, radiography of the esophagus reveals strictures, dilatation of the esophagus over the stenotic area, and moderate esophagitis. Endoscopic examination in the subacute period makes it possible to detect a necrotic scab, determine the boundaries of the lesion, visualize granulations and forming scars. In the chronic stage of the process, various types of scar changes can be identified: valve, ring-shaped, tubular, etc. Occasionally, esophageal scars can become malignant.

Treatment of esophageal burn

First aid for a burn of the esophagus can be provided at the prehospital stage or in the surgical and intensive care units. Immediately after receiving a burn to the esophagus, you should rinse your mouth with plenty of clean water at room temperature and drink two glasses of milk. Inducing vomiting to remove a chemical from the stomach is not recommended as this may cause rupture of the esophagus.

After admission to the hospital, a gastric tube is inserted, abundantly irrigated with oil. Before inserting the probe, local anesthesia is applied to the oral and pharyngeal mucosa. The contents of the stomach are removed through the tube and the damaging substance is inactivated. In case of a burn with alkali, the stomach is washed with a non-concentrated solution of acetic acid or oil; the acid is neutralized with a soda solution. If it is not known exactly what caused the burn, it is recommended to rinse the stomach with plenty of water or introduce milk through a tube. The stomach should be rinsed only in the first six hours after receiving a burn; in the future, this procedure is not advisable.

Immediately after inactivation of the damaging agent, an antibiotic is administered to prevent purulent complications, the patient is anesthetized and sedated, and detoxification and anti-shock therapy begins. With a first-degree burn of the esophagus, you can start feeding the patient already on the second or third day of hospital stay. In case of a second degree burn, feeding does not begin until the seventh or eighth day. In case of third degree burns, the issue of enteral nutrition is decided on an individual basis.

On the seventh to tenth day after receiving the burn, bougienage of the esophagus begins. The procedure involves daily insertion of bougies of increasing diameter into the lumen of the esophagus, which helps to expand the lumen and reduce scarring. If in the acute period of the burn therapeutic measures were carried out in full, and in the subacute phase the esophagus was properly bougienage, then satisfactory results of restoring the patency of the esophagus are achieved in 90% of cases.

If, in the long term, severe cicatricial strictures, significant stenosis of the esophagus, or its complete obstruction develop, surgical treatment is performed (stenting of the esophagus, endoscopic dissection of cicatricial stricture of the esophagus, endoscopic dilation of esophageal stenosis, esophageal plastic surgery).

Forecast and prevention of esophageal burn

The prognosis for a burn of the esophagus is determined by the type, amount and concentration of the chemical solution; severity of the burn; pH level of the liquid (the most severe damage develops at a pH below 2 and above 12); correct provision of first and further medical aid; the presence and severity of complications. The most unfavorable prognosis for third-degree burns of the esophagus is that mortality in this group reaches 60%. In other patients, the prognosis is more favorable; with proper assistance, normal functioning of the esophagus is maintained in 90% of patients. Prevention of burns to the esophagus means following the rules for storing hazardous and caustic substances: separately from drinks and food, out of the reach of children, in specially marked containers.

Esophagus burn There are two types: thermal and chemical. Thermal is caused by swallowing hot food. But in most cases, a chemical burn occurs - damage to the walls of the esophagus by aggressive and caustic chemicals. This can happen if these liquids are accidentally ingested, if you lack self-control while intoxicated, or if you attempt suicide.

Most often, a chemical burn of the esophagus is caused by:

Concentrated acids (acetic essence, hydrochloric sulfuric acid)
Alkalis (caustic soda, caustic soda, sodium hydroxide)
Other substances: phenol, lysol, ethyl alcohol, tincture of iodine, sublimate, ammonia, silicate glue, potassium permanganate solution, acetone, hydrogen peroxide, electrolyte solutions.

Along with a burn of the esophagus, lesions of the mucous membrane of the mouth, pharynx and stomach often occur.
70% of victims are children aged one to ten years. This statistic is due to the natural curiosity of babies and their habit of tasting everything. The rest are adults who accidentally or intentionally drank caustic liquids. Among those who tried to commit suicide using chemicals, the majority were women.

It is believed that a burn to the esophagus with acid is more easily tolerated than with alkali. This is explained by the fact that in the first seconds, when acid enters, a kind of film (scab) forms on the mucous membrane, which prevents further penetration of the substance into deeper layers. In addition, the acid concentration is reduced due to the water that is released from the affected tissues.

Burns caused by alkalis often have more severe consequences. This is caused by the peculiarity of the chemical reaction occurring in the tissues. Proteins are destroyed, fats are saponified, and a gelatinous mass is formed from the cells. Alkali easily passes through it, causing necrosis (necrosis) of the deeper layers of the esophagus. Even if small amounts (20-50 ml) are swallowed, a hole may form in the wall of the esophagus.

Most often, accidental ingestion of liquid is caused by improper storage. Containers are placed in places accessible to children. Bright labels of household chemicals attract children's attention and arouse interest. It happens that chemicals are poured into containers not intended for their storage: glass jars, plastic bottles. Lack of labels and warnings that the liquid is poisonous may lead to its accidental use for other purposes.

Anatomy of the esophagus

The esophagus is part of the gastrointestinal tract. It is a muscular tube 25-30 cm long. Its function is to ensure the passage of chewed food from the pharynx to the stomach.

In cross section, the esophagus has a star-shaped appearance due to folds and grooves. This structure helps the fluid move faster. In the case when it is necessary to swallow a portion of solid food, the folds are smoothed out and the lumen of the esophagus expands.

The wall of the esophagus consists of three membranes:

Mucous membrane lines the inside of the esophagus. Its glands produce mucus, which facilitates the passage of food.
Muscularis makes up the middle layer of the esophagus. Has two layers of smooth muscle. Some go along the esophagus, others encircle it with rings. Their task is to ensure the movement of swallowed food from the pharynx to the stomach.
Connective tissue membrane (adventitia) limits the esophagus and makes it possible to change the width of its lumen.

The esophagus begins and ends with sphincters. These are muscle rings that look like thickenings of the walls of the esophagus. Their task is to let or not let food into the gastrointestinal tract and prevent it from refluxing from the stomach into the esophagus. The esophagus has three narrowings and two expansions. This feature is associated with the adjacency of other internal organs to it: the aorta, diaphragm.

Symptoms of a burn to the esophagus

Local symptoms of esophageal burn

The tissues of the esophagus are penetrated by nerve endings. Therefore, their burn causes severe pain. It is felt in the neck, behind the sternum and in the upper abdomen. Traces of burns and swelling are noticeable on the lips and in the oral cavity.

As a result of damage to the vocal cords by chemicals, hoarseness is observed.

Tissue swelling quickly occurs. As a result, the lumen of the esophagus is blocked and the swallowing process is disrupted.

Immediately after ingestion of an aggressive liquid, damage occurs first to the mucous membrane, and then to other membranes of the esophagus. Chemical compounds destroy cells and cause tissue death. The areas where the esophagus has physiological narrowings are most affected. Cauterizing liquids linger there and cause severe burns.

A 3rd degree burn can create a hole in the wall of the esophagus. In severe cases, the bronchial wall is also destroyed and an esophageal-tracheal fistula occurs.

General symptoms of damage to the body

General intoxication of the body develops. It is caused by poisoning, which occurs due to the accumulation of toxins - products of tissue breakdown. Its signs are fever, severe weakness, nausea, and cardiac dysfunction.

Kidney-liver failure can result from damage to the body by toxins. The kidneys and liver, which are responsible for clearing the blood of waste products, are unable to cope with their task.

The severity of damage to internal organs depends on the concentration of the chemical and the amount of liquid ingested.

There are three degrees of esophageal burn:

I degree, the easiest. The lesion affected only the upper layers of the epithelium, which covers the mucous membrane of the esophagus. There is redness, swelling, and increased vulnerability. All phenomena disappear within 10-14 days.
II degree, average. The mucous membrane and submucosal layer of muscle cells are destroyed. In this case, severe swelling occurs, which can completely block the lumen of the esophagus. The lesions have the appearance of ulcerations, which are gradually covered with a layer of fibrin fibers, a blood plasma protein. If no complications arise, the surface of the esophagus heals by the end of 3-4 weeks.
III degree– heavy. The lesion covers all layers of the esophagus and can spread to the surrounding tissue and nearby organs. In this case, common phenomena arise - intoxication and shock. During the healing process, scar processes develop. Narrowing and shortening of this organ is possible. If emergency care is carried out correctly, healing lasts from three months to two years.

Treatment of esophageal burn

Treatment of a II-III degree burn of the esophagus is carried out in a hospital. This is necessary to prevent serious complications (bleeding, esophageal rupture, sepsis). It is impossible to independently determine the degree of burn. Therefore, if you swallow cauterizing liquids, call an ambulance as soon as possible.

Depending on the extent of the damage, the patient is hospitalized in the intensive care unit or intensive care unit.
The treatment is carried out by a toxicologist.

First aid to the victim

The first thing to do is gastric lavage. The victim is given a liter of water to drink and vomited to remove the chemical compounds.

The next step is to neutralize the substance. In order to properly provide first aid, it is necessary to determine what caused the burn of the esophagus. It is often impossible to interview the victim: state of shock, childhood. Then you need to try to determine this by the smell of your breath or find the container in which the chemicals were located.

If it is determined that the burn was caused by acid, then to neutralize its effect it is necessary to rinse the stomach with alkali. To do this, use a 2% solution of sodium bicarbonate (2 g per liter of water). At home, you need to dilute half a teaspoon of baking soda in a liter of lukewarm boiled water and drink in small sips. After this, try to induce vomiting.

As first aid for a burn of the esophagus with alkali, gastric lavage is used with a weak solution of acetic, citric acid or vegetable oil.

If the burn is caused by potassium permanganate KMnO4, then wash with a 1% solution of ascorbic acid.
If the cause of the burn cannot be determined, the effect of the chemical compound can be neutralized with milk. Give 2 glasses of milk in small sips, warm but not hot.
It is important to rinse within the first 6 hours after drinking the liquid.

Treatment of a burn of the esophagus in a medical institution

If the patient has a spasm and cannot swallow, then gastric lavage is carried out in the hospital through a tube. Before this, it is generously lubricated with oil. Analgesics are pre-administered to anesthetize the procedure - promedol 1 ml. 2% solution or atropine sulfate. In addition, local anesthesia of the mouth and pharynx is performed.

Complex treatment of chemical burns of the esophagus:

For pain relief, promedol, morphine, and analgin are used.

To relieve spasm of the esophagus, atropine 0.5-0.6 ml is prescribed.

Relanium is used as a sedative to relieve agitation.

To relieve shock - prednisolone, sodium bicarbonate solution, rheopolyglucin, intravenous saline solutions.

To prevent the formation of scars on the walls of the esophagus, adrenal cortex preparations are administered.

To prevent infectious complications, broad-spectrum antibiotics are used - cefamezine, ampiox

If necessary, medications are prescribed to normalize the activity of the heart and kidneys

In the first 5-7 days, vegetable or vaseline oil is prescribed - this promotes better healing of burns. Eating food, even liquid food, is excluded during this period.

In severe cases, the patient undergoes gastrostomy. This is an opening into the stomach cavity through the anterior wall. This is necessary for nutrition in the first weeks after a burn.

In the first days, in case of a II-III degree burn, X-rays and endoscopic examination are not prescribed, so as not to further injure the esophagus.

To prevent narrowing of the esophagus, bougienage is prescribed. This is a procedure for gradually widening the esophagus using elastic probes of different diameters. Such manipulations begin from 5-7 days and are repeated for several months after the mucous membrane has healed.

The forecast depends on:

the type of solution that caused the burn and its quantity.
degree of damage, with degrees 1-2 it is favorable
pH level of cauterizing liquid - liquids with a pH less than 2 and more than 12 cause severe damage
correctness and timeliness of first aid and further treatment
complications that occur after a burn

In the most severe cases - stage 3 - mortality can reach 50-60%. In other cases, the prognosis is favorable. Timely and correct treatment of a burn of the esophagus gives favorable results in 90% of cases.

Prevention of esophageal burns

The main measures to prevent burns of the esophagus include proper storage of household chemicals. Substances that are cauterizing liquids must be stored separately from food products.

Keep household chemicals out of the reach of children. If everyone heeded this warning written on every label, there would be far fewer accidents.

It is especially dangerous to pour chemicals into food containers: cans, bottles. These liquids are mistakenly mistaken for water and drunk, resulting in a burn to the pharynx and esophagus.

About 70% of burns are caused by ingesting vinegar essence. Based on this, you should stop using it and replace it with vinegar.

Caustic soda, which is used to clean pots and pipes, should not be stored in the kitchen. It does not have a pungent specific odor and is mistaken for baking soda.

In previous years, up to 10% of victims received burns after drinking a strong solution of potassium permanganate, which was used as a disinfectant. Therefore, if you still have supplies of this drug, do not dilute it in mugs and do not leave the prepared solution where children or other family members can get it.

Conversations with children on the topic of safety play an important role in the prevention of esophageal burns. It is necessary to promptly tell your child what dangers household chemicals pose and why they should not be used for other purposes.

Answers to frequently asked questions:

What causes esophageal burns in children?

The majority of victims - up to 45% - are children under 7 years old. The older the child, the lower the risk that he will take unsuitable liquid into his mouth. According to statistics from specialized departments of children's hospitals, the main cause of esophageal burns in children is vinegar essence (about 60%). In second and third place are cleaning products and ammonia.

In recent years, the amount of household chemicals based on concentrated acids and alkalis has increased sharply. Each apartment has a variety of liquids in colorful packaging. “Mr. Muscle”, “Mole”, tile and toilet cleaners and stain removers cause severe consequences and disability.

What are the characteristic symptoms of an esophageal burn?

The first symptoms of a burn to the esophagus occur immediately after the cauterizing liquid enters the body.

Signs of a burn to the esophagus:

Severe pain and burning behind the sternum.
Due to swelling of the larynx, there is a lack of air and suffocation.
Traces of burns and necrosis - tissue death - are visible on the lips and mouth.
Spasm of the esophagus causes difficulty swallowing.
Severe salivation occurs.
Vomiting, often mixed with blood. Thus, the body tries to get rid of the chemical compounds that have entered it.

If these symptoms appear, you must immediately call an ambulance.

How to provide first aid for a burn of the esophagus?

The prognosis of the course of the disease and the speed of recovery depend on whether first aid is provided correctly.
First of all, it is necessary to cleanse the body of the substance that caused the burn. To do this, they give water or milk to drink, and then induce vomiting.

After the remaining chemicals have been washed away, you can begin to neutralize their effects. You cannot start from this step. Because the reaction of acid and alkali releases a large amount of carbon dioxide. This may cause suffocation.

If the victim drank acid, then you need to give him a weak solution of baking soda (2 grams per liter of water). If the burn was caused by alkali, then neutralize its effect with a weak solution of vinegar in water or citric acid (3-4 grams per liter).

The ambulance team performs gastric lavage through a tube. Before this, the patient is given 100 ml to drink. novocaine solution for anesthesia of the mucous membrane of the pharynx and esophagus. Analgesics are administered subcutaneously to relieve pain shock. About 10 liters of water are used to lavage the stomach.

After cleaning the stomach, the hospital department begins complex treatment appropriate to the patient’s condition. They take medications that improve the functioning of the heart, kidneys and lungs, hormones, painkillers and drugs for intravenous nutrition.

If the victim can swallow, then in the first days a 5% solution of novocaine is prescribed - 100 ml in small sips throughout the day. It is also recommended to drink vegetable oil with the addition of an antibiotic.

What happens when the esophagus is burned by alcohol (alcohol)?

Alcohol burns occur when strong alcoholic beverages are swallowed. This can happen when consuming medical alcohol 70 or 96% and various tinctures based on it. When the esophagus is burned by alcohol, loss of taste, dizziness and weakness, pain in the neck, chest, and stomach occur.

When the esophagus is burned with alcohol, a white coating of fibrin forms on the surface of the mucosa, which resembles the white of a boiled egg. This is tissue that is dead as a result of an alcohol burn.

96% alcohol tans mucosal cells. A thin film is formed, which delays penetration into deeper layers. Therefore, severe burns do not occur when drinking alcohol. If the stomach has not been filled, a burn to the gastric mucosa may occur. But more dangerous is alcohol poisoning, which occurs when taking large doses of alcohol.

What happens when the esophagus is burned with vinegar?

Table vinegar does not cause severe burns to the esophagus. More severe consequences occur when vinegar is absorbed into the blood. Vinegar destroys red blood cells and kidney failure occurs.

Serious acid damage to the esophagus can occur if vinegar essence is ingested. It has a cauterizing effect. Water leaves the cells of the esophagus, and they turn into a dry crust - a scab.

Although acetic acid, unlike alkalis, does not cause perforation (rupture) of the esophagus, it can cause severe painful shock and damage to internal organs: liver, kidneys, heart.

How to treat a burn of the esophagus with folk remedies?

First-degree chemical burns of the esophagus, after examination by a doctor, can be treated at home with folk remedies.
As first aid for burns of the esophagus, traditional medicine advises drinking a liter of milk or a glass of vegetable oil, or 5 raw egg whites. These products help neutralize the effects of chemicals.

For a speedy recovery, you can use one of the recipes

Stir the white of a fresh egg in a glass of water. Protein forms a film on the burned surface and promotes its healing.

Chamomile tea prevents the development of complications, soothes and relieves inflammation. Brew tea at the rate of 2 teaspoons of flowers per cup of boiling water. Leave for 15-20 minutes. Drink warm throughout the day.

A decoction of flax seed is used as an enveloping agent that promotes mucosal healing and pain relief. To do this, take 12 teaspoons of seeds, add a liter of water and boil over low heat for 10 minutes. After this, let it cool and filter. Drink in small sips throughout the day.

Pour a teaspoon of quince seeds into a glass of boiling water, leave for 30 minutes, then strain. Take 4-5 times a day, 1 tablespoon before meals.

Pour a tablespoon of marshmallow rhizome into 200 ml of boiling water. Leave for 30 minutes, strain. Take a few sips 3-4 times a day.

Tricolor violet herb - 1 tablespoon, pour a glass of boiling water. Leave in a warm place for 2 hours. Strain and drink throughout the day.

Treatment of burns of the esophagus is a complex and lengthy process that can last for years. That's why it's so important to prevent this accident from happening. Take precautions when using chemicals and keep them away from children.

What foods can cause a burn to the esophagus?

By eating hot food, you can get a thermal burn of the esophagus, which will result in the typical symptoms described above in the article. The optimal food temperature is no more than 40°C. It is dangerous to eat food that has not cooled down, especially for children. In addition, constant consumption of hot food can lead to spasms of the esophagus, inflammatory processes, and cancer.

What are the possible consequences of a burn to the esophagus?

The following conditions may develop as a result of a burn to the esophagus::

Esophagitis– inflammatory process in the mucous membrane of the esophagus.
Scar narrowing of the esophagus. The narrowing caused by chemical burns is most often located in the lower part of the esophagus. There can be many areas of scar narrowing, sometimes they stretch along the entire length of the organ. Sometimes scar tissue also grows in the surrounding fatty tissue, causing the esophagus to move to the side. Scar narrowing of the esophagus after burns is eliminated using bougienage(gradual expansion of the lumen) or surgical intervention.
Cicatricial shortening of the esophagus.
Perforation of the esophagus. A hole forms in the wall of the organ. Most often this occurs with alkali burns. In turn, perforation can lead to other, more severe complications.
Mediastinitis- inflammation of the space that is located inside the chest between the lungs and is filled with internal organs ( mediastinum). The inflammatory process develops as a result of penetration of the contents of the esophagus into the mediastinum against the background of perforation.
Esophageal-bronchial and esophageal-tracheal fistulas. With perforation and the development of the inflammatory process, pathological communications may occur between the esophagus and the bronchi and trachea.
Aspiration pneumonia. Thermal and chemical burns of the esophagus are usually combined with lesions epiglottis– cartilage of the larynx, which covers the airways during swallowing. It ceases to cope with its functions; food and saliva entering the lungs lead to the development of pneumonia.
Pleurisy. Inflammation of the pleura - a thin film of connective tissue that covers the outside of the lungs and lines the inside of the chest cavity. May occur as a complication of aspiration pneumonia or esophageal perforation.
Esophageal cancer. After a burn, the risk of cancer increases 10-1000 times. The diagnosis can often be very difficult to establish in the early stages.

Can gastric juice burn the esophagus?

Gastric juice is acidic, and if it enters the esophagus, it can damage its mucous membrane. This happens when gastroesophageal reflux disease (GERD). The effect of gastric juice on the esophageal mucosa can lead to some complications:

erosions and ulcers of the esophagus;
esophageal bleeding;
narrowing of the esophagus;
Barrett's esophagus– a precancerous disease in which cells that differ from normal appear in the mucous membrane of the esophagus;
esophageal cancer.

What is a radiation burn of the esophagus?

Radiation burns of the esophagus are rare. They are caused by the effect of ionizing radiation on the organ and arise, as a rule, as a complication of radiation therapy in the treatment of tumors of the mediastinum and mammary glands. Typically, such radiation burns of the esophagus manifest themselves in the form of inflammation of its mucous membrane - esophagitis. Swallowing is impaired, pain and discomfort occurs in the chest.

How is a burn of the esophagus coded in the ICD?

Depending on the cause of the burn, it is designated by one of two codes:

T28.1– thermal burn of the esophagus;
T28.6– chemical burn of the esophagus.

What happens when the esophagus is burned by soda?

In the past, at the end of the 19th century, poisoning and burns of the esophagus with soda were quite common. But this was not food familiar to all modern people ( sodium bicarbonate), A caustic soda – sodium hydroxide. This very aggressive substance, capable of causing severe burns to the skin and mucous membranes, was previously widely used for the manufacture of various hygiene products.

Currently, burns of the esophagus with caustic soda are extremely rare. Burns of the esophagus caused by another alkali are much more common - ammonia. This substance is often thoughtlessly used to sober up during alcohol intoxication.

What substances most often cause chemical burns of the esophagus?

Acids: acetic, sulfuric, hydrochloric.
Alkalis: caustic soda, caustic potassium, caustic soda, ammonia.
Heavy metal salts: copper sulfate, sublimate.
Strong solution or potassium permanganate crystals.
Phenol.
Alcohol.

Oleg Nikolaevich Inozemtsev,

diagnostician, pediatrician

What types of burns are there?

Burns of the esophagus, depending on the causative factor, can be of two types - thermal and chemical. A thermal burn occurs when hot food is swallowed. This type of burn is not as common as a chemical burn. In a chemical burn, the wall of the esophagus is damaged by caustic and aggressive chemical compounds. A chemical burn to the esophagus can occur as a result of accidental ingestion of caustic liquids when the child is not supervised.

What can cause a chemical burn of the esophagus?

Concentrated acids - acetic essence, hydrochloric sulfur, various alkalis - caustic soda, sodium hydroxide, caustic soda, other chemicals (tincture of iodine, Lysol, phenol, ethyl alcohol, sublimate, silicate glue, ammonia, potassium permanganate solution, hydrogen peroxide, acetone, electrolyte solutions). In addition to the mucous membrane of the esophagus itself, burns damage the mucous membrane of the mouth, pharynx, and stomach.

Statistics

Among all burn victims, 70% of patients are children aged from one to ten years. This age gap is due to the fact that at this age children are the most curious and want to taste everything.

Which is less dangerous?

The burn itself is dangerous, but there is an opinion that a burn of the esophagus with acids is less dangerous and is easier to tolerate than a burn with alkalis. And this is true, and this is due to the fact that when acid gets into the mucous membrane of the esophagus, a scab (film) is formed, which blocks further penetration of the chemical into the underlying tissues. Also in the “favor” of the acid is the concentration of acid that decreases due to the release of fluid from the affected tissues.

Alkali burns are more dangerous and have serious consequences. This is due to the following: proteins are destroyed, fats are saponified, and alkali easily spreads through these damaged loose cells. Therefore, even a tiny amount (20–40 ml) of alkali can cause perforation (formation of a hole) in the wall of the esophagus.

Causes of dangerous liquid entering the esophagus

The most common cause of accidental ingestion of caustic acids or alkalis is their improper storage. As a rule, hazardous substances are kept in places accessible to children. Containers with hazardous chemicals have bright labels that immediately attract the child’s attention, and the child tries to explore the item and taste it. But there are times when caustic chemicals may be poured into a container from some harmless drink (juice, soda, etc.) that the child may recognize as safe and familiar. If adults poured a chemically dangerous compound into such a “familiar” vessel, then it should be hidden away.

A little anatomy

To understand how deeply the tissues of the esophageal wall can be damaged when damaged by a chemical burn, you need to remember the structure of the esophagus. The esophagus is part of the digestive tract and has the form of a tube about 25–30 cm long. Its main function is to ensure that food crushed in the oral cavity enters the stomach. The esophagus has folds that help food move into the stomach. The wall of the esophagus has three layers: the inner mucosa, the glands of which produce mucus; the muscular layer (middle layer) of the esophagus, with the help of which the swallowed liquid and food are promoted; adventitial (connective tissue) membrane that borders the esophagus.

The muscular lining of the esophagus has sphincters (muscle rings) that regulate the passage of food into the gastrointestinal tract and prevent the reflux of food in the opposite direction (from the stomach to the esophagus). The esophagus also has areas of narrowing (three) and widening (two). This is due to the adherence of internal organs (aorta and diaphragm) to the esophagus.

Clinical symptoms of esophageal burn

Symptoms of a burn to the esophagus in children can be divided into local and general.

Local symptoms are symptoms directly in the burn area. Since the wall of the esophagus has many nerve endings, a symptom such as pain will be present first. But pain can be felt not only in the esophagus, but also behind the sternum, in the upper abdomen, and in the neck. Damage from the burn is visible on the lips and in the mouth. If the vocal cords are damaged, the clinical picture is hoarseness or lack of voice.

When the esophagus is burned, edema (swelling) of tissue occurs at the burn site, and as a result, the lumen of the esophagus is blocked, which leads to disruption of the act of swallowing.

As a result of swelling of the laryngeal tissue, shortness of breath occurs. There may be vomiting with blood, mucus, and pieces of damaged tissue.

After ingesting a caustic liquid, the mucous (inner) lining of the esophagus is directly damaged, and then the tissues lying deeper. Necrosis (death) of esophageal cells occurs. And the areas of the esophagus that have physiological narrowings are most damaged. If the burn is very severe (third degree), then a hole (perforation) may form in the wall of the esophagus. In addition, the wall of the bronchus adjacent to the esophagus may collapse and an esophageal-tracheal fistula (communication between the esophagus and bronchus) may form.

General symptoms of a burn of the esophagus are caused by intoxication of the body. Intoxication of the body develops when poisoning occurs as a result of the accumulation of toxins (products of the breakdown of damaged tissue). Signs of intoxication are weakness, increased body temperature, nausea, vomiting, and cardiac dysfunction. In addition, kidney and liver failure may develop due to the inability to cope with tissue breakdown products (toxins).

In general, the severity of the injury in a burn of the esophagus will depend on the amount of the substance taken and its concentration.

Burns of the esophagus can be of three degrees.

I degree – mild. In this case, only the upper layer of the mucous membrane of the esophagus is affected. The first degree of burn is characterized by hyperemia (redness), swelling, and increased vulnerability. With a first-degree burn of the esophagus, healing occurs within 10–14 days.

II degree – average. The mucous membrane and submucosal layer are destroyed. Severe swelling of the esophageal tissue occurs, and the lumen of the esophagus is blocked. The affected areas look like ulcerations covered with a layer of fibrin (blood plasma protein). Without developing complications, such a burn of the esophagus heals in about 3–4 weeks.

Grade III is the most severe. With a severe burn, all layers of the esophagus and even surrounding tissues are damaged. In this case, the symptoms of intoxication intensify to the point of shock. If such a burn heals, then scars form in its place. This leads to narrowing and shortening of the organ. With adequate treatment of a third-degree burn of the esophagus, healing lasts from 3 months to 2 years.

How to diagnose esophageal burns in children

Fibroesophagoscopy, which should be performed within 24–48 hours after receiving the burn, helps in diagnosing the extent of the esophageal burn. Based on the endoscopic picture, the following degrees of burns can be distinguished:

degree. Swelling and redness (hyperemia) of the mucous (inner) lining of the esophagus.

2a degree. Loosening of the mucous membrane of the esophagus, its bleeding, the appearance of erosions, blisters with liquid, and superficial ulcers.

2b degree. The appearance of deep ulcerations.

3a degree. The appearance of small foci of necrosis (death) of the mucous membrane with the formation of dark brown areas.

3b degree. Development of extensive necrosis.

Also, in diagnosing the consequences of a burn of the esophagus, an X-ray examination of the esophagus with a water-soluble contrast agent can be useful. This procedure should be performed 10–14 days after the burn.

Treatment of esophageal burns in children

First aid for burns of the esophagus in children is to lavage the stomach and esophagus. For rinsing, use neutralizing solutions or warm water. Next, it is necessary to carry out adequate pain relief, administer antibiotics to prevent infection, hormones, and oxygen therapy (oxygen therapy).

If the burn is mild (1st degree), then no specific treatment is required.

If a child has 2nd-3rd degree burns, then infusion (intravenous infusions) therapy is necessary to relieve intoxication, prevent dehydration and provide parenteral nutrition.

In case of 2-3rd degree burn of the esophagus, bougienage (expansion) of the lumen of the esophagus may be required to prevent stenosis (narrowing). Bougienage is carried out on the 8th–10th day.

Complications of esophageal burns in children

After a burn of the esophagus, children may develop disorders of the motor function of the esophagus, strictures (narrowing) of the esophagus, gastroesophageal reflux (return of food from the stomach into the esophagus), development of Barrett's esophagus (appearance of atypical cells), carcinoma (malignant tumor) of the esophagus.