Clin Endosc.  2015 Jan;48(1):66-69. 10.5946/ce.2015.48.1.66.

Corrosive Esophagitis Caused by Ingestion of Picosulfate

• Seo JY
• Kang KJ
• Kang HS
• Kim SE
• Park JW
• Moon SH
• Kim JH
• Park CK

• KMID: 2221761
• DOI: http://doi.org/10.5946/ce.2015.48.1.66

Abstract

Corrosive esophagitis is characterized by caustic injury due to the ingestion of chemical agents, mainly alkaline substances such as detergents. Esophageal bleeding, perforation, or stricture can be worsened by high-degree corrosive esophagitis. Picosulfate is a commonly used laxative frequently administered for bowel preparation before colonoscopy or colon surgery. Picosulfate powder should be completely dissolved in water before ingestion because the powder itself may cause chemical burning of the esophagus and stomach. Here, we report a case of corrosive esophagitis due to the ingestion of picosulfate powder that was not completely dissolved in water.

Keyword

Caustics; Esophagitis; Picosulfate

MeSH Terms

Burns, Chemical
Caustics
Colon
Colonoscopy
Constriction, Pathologic
Detergents
Eating*
Esophagitis*
Esophagus
Hemorrhage
Stomach
Water
Caustics
Detergents
Water

Figure

• 

  Fig. 1 Endoscopy performed 15 hours after admission showing corrosive esophagitis. (A) Diffuse linear mucosal breaks with oozing and whitish exudates in the mid-esophagus. (B) Shallow ulcerations with oozing and whitish exudates at the esophagogastric junction. (C) No abnormal findings in fundus except mild erosion in cardia. (D) Linear ulcers with hematins from the mid-body to low-body.

• 

  Fig. 2 Endoscopy performed (A-C) after 10 days, and (D-F) after 5 months of treatment, showing the healing state of corrosive esophagitis. (A) Linear ulcer scars in the mid-esophagus. (B) Linear ulcers with blood clots. No stricture at the esophagogastric junction. (C) Linear healing ulcers in the low-body. (D, E) No mucosal abnormality in the esophagus and stomach. (F) A linear whitish scar in the stomach.

Reference

1. Ramasamy K, Gumaste VV. Corrosive ingestion in adults. J Clin Gastroenterol. 2003; 37:119–124. PMID: 12869880.

2. Poley JW, Steyerberg EW, Kuipers EJ, et al. Ingestion of acid and alkaline agents: outcome and prognostic value of early upper endoscopy. Gastrointest Endosc. 2004; 60:372–377. PMID: 15332026.

3. Gümürdülü Y, Karakoç E, Kara B, Taşdoğan BE, Parsak CK, Sakman G. The efficiency of sucralfate in corrosive esophagitis: a randomized, prospective study. Turk J Gastroenterol. 2010; 21:7–11. PMID: 20533105.

4. Portalatin M, Winstead N. Medical management of constipation. Clin Colon Rectal Surg. 2012; 25:12–19. PMID: 23449608.

5. Hoy SM, Scott LJ, Wagstaff AJ. Sodium picosulfate/magnesium citrate: a review of its use as a colorectal cleanser. Drugs. 2009; 69:123–136. PMID: 19192941.

6. Más A, Chillarón JJ, Esteve E, Navalpotro I, Supervia A. Severe rhabdomyolysis and hyponatremia induced by picosulfate and bisacodyl during the preparation of colonoscopy. Rev Esp Enferm Dig. 2013; 105:180–181. PMID: 23735032.

7. Pace F, Greco S, Pallotta S, Bossi D, Trabucchi E, Bianchi Porro G. An uncommon cause of corrosive esophageal injury. World J Gastroenterol. 2008; 14:636–637. PMID: 18203301.

8. Zargar SA, Kochhar R, Mehta S, Mehta SK. The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns. Gastrointest Endosc. 1991; 37:165–169. PMID: 2032601.

9. Tsukada K, Azuhata H, Katoh H, Kuwano H. Acute gastroduodenal injury after ingestion of diluted herbicide pendimethalin. Singapore Med J. 2009; 50:e105–e106. PMID: 19352552.

10. Di Costanzo J, Noirclerc M, Jouglard J, et al. New therapeutic approach to corrosive burns of the upper gastrointestinal tract. Gut. 1980; 21:370–375. PMID: 6776011.

11. Zargar SA, Kochhar R, Nagi B, Mehta S, Mehta SK. Ingestion of strong corrosive alkalis: spectrum of injury to upper gastrointestinal tract and natural history. Am J Gastroenterol. 1992; 87:337–341. PMID: 1539568.