목적 : 부식제 섭취와 관련된 사망률은 일반적으로 낮지만, 상부 위장관 손상은 빈번하고 심각한 만성 합병증인 상부 위장관 협착을 유발할 수 있으므로 관련된 위험인자를 예측하는 것은 치료와 예후에 중요하다. 저자 등은 부식제 섭취로 인한 초기 위장관 손상정도와 상부 위장관 협착 등 합병증 및 이를 유발하는 임상적, 내시경적 예후인자에 대해 분석하고자 하였다. 방법 : 1993년 3월부터 2004년 7월까지 부식제 섭취 후 내원한 77명의 환자를 대상으로 의무기록을 후향적으로 분석하였고, 위장관 손상의 정도는 Zargar's classification을 기준으로 분류하였다. 결과 : 부식제 섭취 후 내원한 77명의 환자에서 남자는 35명(45.5%), 여자는 42명(54.5%)이었다. 부식제 음독 후 내시경을 시행하기까지 걸린 평균시간은 10시간(범위, 90분∼14일)이었다. 섭취한 부식제의 종류는 산성인 경우가 45명(58.4%), 염기성인 경우가 32명(41.6%)이었다. 합병증으로는 식도 협착 12명, 위 협착 3명, 출혈 2명, 사망 2명이 발생하였다. 출혈이 발생한 환자 2명과 사망한 환자 2명의 식도, 위, 십이지장 손상 정도는 모두 각각 grade III를 보였다. 식도와 위의 손상 정도는 식도 협착과 의미있는 상관관계가 있었고, 위 협착은 발생한 환자 수가 적어 통계적인 의미를 구하기는 어렵지만 모두 손상 정도 grade III의 경우에 발생하였다. 그 외 환자의 나이, 알코올 섭취 여부, 정신질환 여부, 부식제 섭취 동기 등은 식도 협착이나 위 협착과 의미있는 상관관계를 보이지 않았다.

Background : Accidental or suicidal ingestion of caustic agents is not uncommon. The caustic injury of upper digestive tract can lead to severe stenotic sequelae. We attempt to investigate clinical characteristics, endoscopic findings and predisposing factors of development of complications of caustic injury. Methods : The medical records of 77 patients admitted to our department for caustic ingestion from March, 1993 to June, 2004 were reviewed. All patients underwent initial endoscopic examinations and caustic lesions were graded according to Zargar's classification (Grade 0～III). Results : Strictures of the esophagus and the stomach occurred in 12 patients (15.6%) and 3 patients (3.9%), respectively. The development of esophageal or gastric stricture was more frequent when the grade of caustic injury of the esophagus or the stomach was more severe. Hemorrhage from exposed vessels of the injured esophagus and stomach was seen in one patient and so was jejunal hemorrhage. Two patients (2.6%) died of multiple-organ failure. All cases of hemorrhage and death resulted from grade III lesions of the esophagus, stomach and duodenum. The type or amount of the caustic agent, duration between ingestion and endoscopic examination, and initial treatment with steroid and/or antibiotics did not correlate with the development of stricture. Conclusions : Caustic injury of the esophagus and the stomach was significantly associated with esophageal stricture. Early endoscopic examination was very useful for predicting the development of complications and prognosis after caustic injury.(Korean J Med 70:371-377, 2006)

Background : Accidental or suicidal ingestion of caustic agents is not uncommon. The caustic injury of upper digestive tract can lead to severe stenotic sequelae. We attempt to investigate clinical characteristics, endoscopic findings and predisposing factors of development of complications of caustic injury. Methods : The medical records of 77 patients admitted to our department for caustic ingestion from March, 1993 to June, 2004 were reviewed. All patients underwent initial endoscopic examinations and caustic lesions were graded according to Zargar's classification (Grade 0～III). Results : Strictures of the esophagus and the stomach occurred in 12 patients (15.6%) and 3 patients (3.9%), respectively. The development of esophageal or gastric stricture was more frequent when the grade of caustic injury of the esophagus or the stomach was more severe. Hemorrhage from exposed vessels of the injured esophagus and stomach was seen in one patient and so was jejunal hemorrhage. Two patients (2.6%) died of multiple-organ failure. All cases of hemorrhage and death resulted from grade III lesions of the esophagus, stomach and duodenum. The type or amount of the caustic agent, duration between ingestion and endoscopic examination, and initial treatment with steroid and/or antibiotics did not correlate with the development of stricture. Conclusions : Caustic injury of the esophagus and the stomach was significantly associated with esophageal stricture. Early endoscopic examination was very useful for predicting the development of complications and prognosis after caustic injury.(Korean J Med 70:371-377, 2006)

Caustic ingestion, Endoscopy, Complication, Predisposing factor