One of the most controversial aspects of caustic ingestion management is the use of steroids to potentially decrease the risk of stricture formation. The ability of steroids to inhibit the inflammatory response led to the hypothesis that steroids may decrease stricture formation after caustic ingestion. The largest study of steroid use in human caustic ingestions was not able to demonstrate a benefit from steroid use.11 Opponents of steroid use believe that steroids may increase the risk of infection, perforation, and hemorrhage. However, no compelling data support these fears in caustic ingestions. 1213 Steroid use has never been recommended in acid ingestions, because the risk of esophageal stricture formation is believed to be lower. Recommendations vary for steroid use after alkali caustic ingestions from not using steroids at all to using them only in endoscopic grade 2b lesions (circumferential deep ulcerated lesions). Steroids are not indicated in grade 1 and grade 2a lesions because these lesions do not form strictures and grade 3 lesions are probably best handled by surgical resection. Steroids, if used, should be used early, within the first 6 h, at a dose approximately equivalent to 2 mg/kg/24 h of prednisolone for 3 weeks, followed by a taper.
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