The effects of liquid bleach ingestion on children's esophageal and gastric mucosa.

Abstract

Objectives: The ingestion of caustic substances is currently a significant health concern in pediatric age, being bleach products among the most commonly ingested. The management of children having ingested bleach is currently controversial since scientific data on their degree of toxicity toward the esophageal and gastric mucosa are currently very poor. Therefore, our study aims at comprehensively analyzing the effects of bleach ingestion in children as well as at evaluating patterns of ingestions, clinical symptom development, and endoscopic findings.

Methods: This prospective observational study was carried out between January 2017 and December 2023 at the Pediatric Department of Santobono Children's Hospital in Naples. Children aged 0-18 years admitted for bleach ingestion were enrolled.

Results: One hundred children with a mean age of 58.7 months were included in the study. Eighty-nine/100 (89%) children had ingested household bleaches (both chlorine- or peroxidase-based) while 11/100 (11%) had ingested homemade or industrial bleaches. The latter were significantly more likely to develop esophagogastric lesions, while children having ingested commercially available household bleaches did not report significant mucosal lesions.

Conclusions: Our data suggest that the toxicity of commercially available household bleaches on the gastrointestinal tract is very low. Therefore, digestive endoscopy is generally unnecessary in case of household bleach ingestion. Conversely, a timely endoscopic evaluation and close follow-up should be performed in children who ingest homemade or industrial bleaches.