Caustic Esophagitis
Lye Stricture

General Considerations 

• Starting in 1967, lye (concentrated sodium hydroxide) became available as a liquid in drain cleaners and caustic esophagitis became a serious medical problem
• Other household agents which can produce caustic esophagitis are acids, ammonium chloride, phenols and silver nitrate
• Lye produces tissue damage through liquefaction necrosis as opposed to acids which produce coagulative necrosis.  Both acidic and alkaline agents can damage esophagus.
• There are 3 phases to caustic esophagitis:
• The acute necrotic phase (1-4 days)
• The ulceration-granulation phase (3-5 days)*
• Fibrosis and stricture formation (3-4 weeks after ingestion)
• Esophagus most prone to perforate during this phase
• As little as 1cc of lye can produce full-thickness necrosis of the esophagus within 30 minutes of ingestion.
• Early changes are better evaluated with endoscopy than contrast studies 

Imaging 

• Mediastinal emphysema
• Left pleural effusion
• If a contrast study is done, water-soluble contrast is used in the cute phase
• Long, smooth esophageal strictures, usually in the distal esophagus
• About 20% have associated gastric abnormality, usually antral narrowing and ulceration
• In the acute phase, a water-soluble esophagram should be performed, followed by barium if no leak is seen. 

Treatment

• Early treatment may include steroids, antibiotics and, some suggest, prophylactic dilatation. Still as many as 40% will develop strictures.
  

Prognosis 

• There is a significantly higher risk of developing esophageal carcinoma 20-40 years after ingestion.
• Esophageal perforations may occur
  
  
  

 
Caustic Esophagitis. Image from a single-contrast barium swallow performed several years after the accidental ingestion of lye demonstrates a long, smooth distal esophageal stricture as evidenced by lack of normal distension of the esophagus.