Corticosteroids can't counter caustics.

Corticosteroids can't counter caustics

The standard therapy for children who have consumed caustic chemicals provides no real benefit, a new study demonstrates. With no alternative treatment available, the finding underscores the need for preventive measures such as expanding the use of childproof packaging and improving safety education, researchers say.

Each year, an estimated 26,000 U.S. children under 6 years of age ingest corrosive chemicals -- mostly household products such as detergents and drain openers. A cascade of tissue-destroying reactions typically ensues for two to three weeks, in some cases ultimately reuiring esophageal replacement.

The corticosteroid prednisone has remained the treatment of choice for the past few decades, although several studies have questioned its use. In the most thorough analysis yet of prednisone's value in childhood corrosive injury, Kathryn D. Anderson and her colleagues at Children's National Medical Center in Washington, D.C., used fiber-optic viewers to track esophageal healing in 60 children who had ingested caustic materials. About half had been treated with prednisone. In terms of lasting damage or need for esophageal replacement, the untreated group healed as well as the treated group, the researchers report.

The finding is sobering, says Frederick H. Lovejoy of Children's Hospital in Boston. "Corrosive injury to the esophagus in children is a completely preventable disease," he notes in an editorial accompanying the research report in the Sept. 6 NEW ENGLAND JOURNAL OF MEDICINE. The new study, he says, "has removed any false security derived from believing that an effective medical treatment exists."