Effectiveness of Corticosteroid Therapy for Caustic Esophageal Injury

Background: Delayed caustic injury complications are common, especially in developing countries, and several treatments have been proposed to prevent the resulting esophageal strictures so far. Although inflammatory nature of caustic injury makes the anti-inflammatory agents a viable option, few studies have investigated these agents. High-dose corticosteroids therapy for reduction of stricture formation in the esophagus after the ingestion of caustic material is still a controversial topic. In this regard, this study aimed to determine the impact of high doses of methylprednisolone in preventing esophageal stricture. Methods: A total of 112 patients with grade II esophageal caustic injury, diagnosed by esophagogastroscopy within 24 hours of injury, were enrolled in our study. The treatment group (n=44) received methylprednisolone (1 g/d for 3 days), pantoprazole, ceftriaxone, and metronidazole and the control group (n=58) received the same regimen excluding methylprednisolone. Endoscopic and radiologic findings were used to compare the severity of the damage to the esophagus and stomach between the two groups. Results: After 8 months of follow-up, stricture development was observed in 3 (5.6%) patients in the treatment group and in 11 (19%) patients in the control group. The difference was statistically significant (P=0.038). The gastric outlet obstruction was observed in 4 (7.4%) patients in the treatment group and in 19 (32.7%) patients in the control group. Again, the difference was statistically significant (P<0.05). There were not any side effects due to the high doses of methylprednisolone in the study group.