Esophageal Injury and Trauma

Your child's esophagus can become damaged if they ingest toxic chemicals or foreign objects, or if they experience physical trauma to this organ. Ingestion of caustic substances, such as oven and drain cleaners, lye, laundry and dishwasher detergents, and batteries are common causes of esophageal injury in children. Depending on the substance and the amount of the substance ingested, children can develop esophageal burns, esophageal strictures, and esophageal perforation (a hole in the esophagus).

Some children may not show any symptoms after swallowing a caustic substance or object. However, damage to the esophagus can still occur, regardless of whether or not your child exhibits symptoms. In other words, symptoms may not reflect the severity of the injury. When symptoms do occur, they may include:

• Dysphagia (difficulty swallowing)
• Drooling
• Abdominal or chest pain
• Refusal to eat
• Breathing problems

Injury from caustic substances tends to worsen over time. Some symptoms may not develop until a few hours after ingestion. Strictures are the main complication of esophageal injury and develop in up to half of people who have esophageal burns as the result of caustic substance ingestion. Children who ingest caustic substances may also be at increased risk for esophageal cancer later in life.

Ingestion of caustic substances is a major cause of esophageal injury. Common harmful products include oven and drain cleaners, toilet bowl cleaners, swimming pool products, hair relaxers, lye, laundry and dishwasher detergents, disk batteries, battery acid, and bleach. Both acidic and alkaline substances can damage the esophagus, although alkaline substances (such as batteries and lye) appear to cause more severe injuries.

Other causes of esophageal injury include:

• Previous surgery on the esophagus
• Physical trauma to the esophagus or chest
• Ingestion of foreign objects
• Chronic gastroesophageal reflux 
• Severe vomiting
• Tumors

If a physician suspects that your child may have an esophageal injury, they will ask detailed questions, including whether your child may have ingested any caustic substances or foreign objects and what, if any, symptoms are present.

Depending on your answers, the physician may order certain tests to get a better understanding of any possible damage. These tests may include:

• Esophagram (or barium swallow), in which your child drinks a special contrast liquid that shows up on X-ray and allows the radiologist to see parts of the body clearly
• Endoscopy, in which a thin and lighted tube is placed through your child's nose or mouth into the esophagus to view inside it
• Chest X-ray to evaluate any respiratory (breathing) problems can help identify complications such as esophageal perforation
• Computed tomography (CT) or magnetic resonance imaging (MRI) to further evaluate possible damage

The treatment for esophageal injury depends on the type and extent of damage. If your child has developed esophageal strictures, the physician will likely recommend dilation. In this procedure, your child's physician will guide an endoscope — a long, thin, flexible tube equipped with lights and a tiny camera — into your child's mouth and esophagus. The doctor will then guide a tiny balloon through the endoscope and into the stricture, inflating it just enough to stretch the abnormal tissue in the esophagus.

A small tube called a stent or a sponge may also be inserted into the area of the stricture. The stent or sponge keeps the esophagus open as the tissue around it heals; it is removed later in a follow-up procedure.

In cases where dilation is not effective, your child's doctor may recommend surgery.

Ingestion of caustic substances is an emergency that requires immediate medical attention. If your child develops esophageal burns, strictures, or perforation, they will need follow up and treatment by a specialist. The skilled clinicians in the Esophageal and Airway Treatment Center at Boston Children's Hospital use the latest diagnostic tests and therapeutic approaches to evaluate and treat esophageal injury so that your child can regain the ability to swallow normally.