Endoscopic Findings and Clinical Outcomes in Adults Following Acidic and Alkaline Caustic Ingestion: A Retrospective Study at a Tertiary Care Hospital

Abstract

 Introduction: Caustic ingestion is a critical medical emergency with potential for significant gastrointestinal injury and long-term complications. This retrospective observational study, conducted at KIMS Hospital (Tertiary care hospital), Bangalore Urban, Karnataka compared endoscopic findings and clinical outcomes among adult patients who ingested either acidic or alkaline substances. The study aimed to evaluate differences in demographics, intent of ingestion, mucosal injury severity, treatment approaches, and short-term outcomes. Material and Methods: Adult patients with caustic ingestion who underwent endoscopic evaluation within 96 hours of ingestion at KIMS hospital between April 2022 and April 2025 were included. Data on demographics, type and amount of substance, intent, comorbidities, Zargar grading, treatments, and outcomes were collected. Exclusion criteria included hemodynamic instability, perforation, severe respiratory distress, non-corrosive ingestion, or confounding comorbidities. Descriptive statistics summarized patient characteristics, while Mann-Whitney and Chi-square tests assessed differences between acidic and alkaline groups, with significance set at p<0.05. Results: A total of 88 patients were included. Age and gender distribution were similar across groups. Suicidal ingestion predominated, and most patients had no comorbidities. Sulphuric acid and sodium hydroxide were the most commonly ingested substances in their respective groups. Zargar grading showed comparable mucosal injury severity in the esophagus, stomach, and duodenum. Conservative management was the primary approach for both groups.Although overall recovery was high, the alkaline group had slightly higher mortality and significantly more post-treatment complications (p=0.03). One-month follow-up showed significantly more antral gastritis and fewer complication-free cases in the alkaline group. Conclusion: Both acidic and alkaline ingestions resulted in similar injury severity and required primarily conservative management. However, alkaline agents were associated with more complications and poorer short-term outcomes, underscoring the need for close follow-up and individualized care in these patients.