Management of Caustic Esophageal Injuries and Risk Factors for Stricture Formation at Bouaké University Hospital

Abstract

Objective: To analyze the management of caustic esophagitis and to identify the factors associated with the development of esophageal stricture in a referral center in sub-Saharan Africa. Patients and Methods: We conducted a retrospective, descriptive and analytical study based on the medical records of patients managed in the Gastroenterology Department of Bouaké University Hospital from January 2015 to December 2024. Eligible patients were those hospitalized for caustic ingestion with a minimum follow-up of eight weeks. Initial management strategies and subsequent stricture formation were assessed. A p-value < 0.05 was considered statistically significant. Results: Sixty-eight patients were included. The mean age was 24.1 years, with a male predominance (sex ratio 1.34). Rural residents accounted for 30.9%, and farmers were the most represented occupation (26.5%). The mean delay to care was 3.5 days. Severe lesions (Zargar grade) were found in 54.4% of cases. Corticosteroids, antibiotics, and PPIs were administered in 35.3%, 58.8%, and 75% of patients, respectively. After follow-up, esophageal stricture occurred in 39.7%. On analysis, lack of PPI therapy in the initial management was the only therapeutic factor significantly associated with stricture formation. Conclusion: Caustic ingestion primarily affected young adults, with a slight male predominance. More than half of the patients presented with severe esophageal injuries, which were significantly associated with stricture formation. Medical management commonly included proton pump inhibitors (PPIs) and corticosteroids; however, only PPIs demonstrated a protective effect against the development of esophageal stricture.