Injuries by strong acids produce coagulation necrosis. Tissue destruction and cell death result in eschar formation, which is believed to protect against deeper injury. Ingested acids settle in the stomach, where gastric necrosis, perforation, and hemorrhage may result. It was previously thought that acids were esophagus sparing, with most tissue injury concentrated in the stomach, but a study by Zargar and colleagues4 reported a similar incidence of gastric and esophageal injury (85.4 percent gastric and 87.8 percent esophageal) after acid ingestion. Despite relatively less tissue destruction, strong acid ingestion results in a higher mortality rate than does strong alkali ingestion. This higher mortality rate after acid ingestion is hypothesized to result from complications of systemic absorption of acid (metabolic acidosis, hemolysis, and renal failure).
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