Caustic Esophagitis

Michael P. Federle, MD, FACR

Key Facts

Terminology

Esophageal injury due to ingestion of strong alkali or acid

Imaging

Nondistensible, shortened, rigid segment (stricture) of esophagus with ulcerated mucosa
Accidental or intentional ingestion of caustic agents (lye > acid)
Causes mild to severe injury to upper GI tract: Esophagus > stomach > duodenum
Acute mild phase
- Atonic dilated, aperistaltic esophagus
Stage 1: Acute necrotic phase (1-4 days)
- Extensive ulceration and narrowed lumen with irregular contour
- May have signs of perforation (gas, fluid in mediastinum)
Stage 2: Ulceration-granulation phase (5-28 days)
- More defined ulcers, spasm
Stage 3: Cicatrization and scarring (3-4 weeks)
- Long or short segmental strictures: Smooth, concentric, and symmetric or irregular, eccentric
- Proximal part of stomach is pulled into chest by shortening of esophagus
Imaging evaluation: CECT for acute injury; barium esophagram for chronic

Top Differential Diagnoses

Radiation esophagitis
Reflux esophagitis
Esophageal carcinoma
Iatrogenic injury: Feeding tubes

Clinical Issues

Complications: Perforation, mediastinitis, peritonitis, fistulas, shock

(Left) Graphic shows a long stricture of the esophagus and ulceration of the mucosa. The stomach is pulled up into the chest due to foreshortening of the esophagus by fibrosis &/or spasm. (Right) Spot film from a barium esophagram in a patient with chronic stricture