Stomach burn

Intentional or accidental ingestion of scalding hot or corrosive mucous membranes and tissue liquid substances leads to a burn of the stomach. As a rule, it is accompanied by a burn of the esophagus, pharynx and oral cavity, which are the first to encounter an aggressive environment.

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Epidemiology

Chemical burns of the stomach are not uncommon, most often these are the consequences of satisfying children's curiosity (3/4 of burn cases occur in children, mainly preschoolers), who taste household chemicals, strong alcohol or medicinal tinctures left in accessible places by careless parents.

The remaining quarter are adults who ingest chemicals by mistake or intentionally. The corrosive substances are ingested by mistake, mostly by drinkers looking for alcohol hidden from them. The fatal outcome occurs in about 2% of cases.

Attempts to commit suicide with aggressive chemicals are almost always committed by women, their choice usually falls on vinegar essence. About a third of such attempts are successful, the rest lead to disability.

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Causes stomach burn

This pathology occurs as a result of a reaction to very hot food, boiling water or prolonged inhalation of hot steam entering the stomach – a thermal burn. Such cases are rare and less dangerous, since only the mucous membrane is affected, and deeper tissues remain undamaged.

Much more often, doctors encounter chemical burns caused by corrosive liquids: acid (hydrochloric, sulfuric, acetic), alkali (caustic soda), alcohol-containing concentrated solutions (medicinal plants, iodine, ammonia), gasoline, acetone, potassium permanganate solution, household chemicals. Chemical burns entail more severe consequences, including tissue necrosis and perforation.

The most common cause of stomach burns is accidental ingestion of a scalding liquid, and accidents are caused by a careless attitude towards storing hazardous substances. Risk factors for this injury include storing household chemicals, medicinal tinctures and other caustic liquids in places accessible to young children, placing hazardous substances near food products in containers without labels.

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Pathogenesis

Ingestion of hot and caustic substances causes burns to the esophagus and stomach and changes in their tissues. In the stomach, the narrow parts are most aggressively affected - the cardiac (connection to the esophagus) and pyloric (outlet to the small intestine).

It is believed that if concentrated acid is ingested, the esophagus will suffer more, since the gastric mucosa is more resistant to the action of acid, and the consequences of the penetration of alkaline substances are more harmful to the stomach. The caustic substance leads to the destruction of the epithelial and subsequent layers of tissue of the esophagus and stomach. The severity of the damage is determined by the characteristics of the burning liquid, its concentration and volume. The walls of the stomach suffer to a lesser extent if it is filled with recently ingested food.

The damaged tissues are rejected, leaving a lumpy (scar) surface in its place, the epithelialization of which occurs very slowly. Then the lumen of the esophagus narrows until it is completely closed in one or more places, the pylorus of the stomach also narrows, sometimes its complete obstruction occurs. In severe cases of damage, the entire stomach shrinks. Obstruction of the esophagus and/or stomach leads to dystrophy and dehydration of the patient.

Liver and kidney failure occur, the function of the adrenal glands and other organs is disrupted due to neurotrophic disorders and poisoning of the body with toxins, absorption of tissue necrosis decomposition products, and secondary infection.

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Symptoms stomach burn

An aggressive reagent swallowed intentionally or accidentally causes a burn of the mouth and esophagus on its way to the stomach, its traces are clearly visible on the lips and in the mouth.

The first signs of a stomach burn are a burning pain in the epigastric region, which can radiate to the chest area and neck; muscle spasms in the affected organs and vomiting. Swelling of the larynx causes swallowing, breathing and pronunciation disorders; intoxication with decomposition products causes fever and tachycardia. Mucus, blood and particles of gastric epithelium are observed in the vomit. In case of ulcerative and necrotic burns, collapse may occur.

Burns of the esophagus and stomach are dangerous not only because of the destruction of the tissues of these organs, but also because of subsequent intoxication, complicated by metabolic disorders, pulmonary edema, and dysfunction of the liver and kidneys.

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Stages

Three clinical stages are classified:

• acute - necrosis of the affected tissues of the stomach wall;
• rejection of necrotic areas;
• scarring of the surface of the inner wall of the stomach, stenosis of the pyloric region (more common) or the entire stomach.

Severity levels are considered in relation to the damage caused to the stomach tissue:

• first degree burn (catarrhal) – only the surface of the mucous membrane is affected, it is edematous and hypersensitive;
• second degree burn (erosive) – the gastric mucosa is completely damaged, it becomes necrotic and is rejected;
• third-degree burn (ulcerative) - not only the mucous tissues are damaged, but also the deeper layers of the stomach wall, there is a high probability of its perforation and further inflammation of the abdominal cavity;
• fourth-degree burn (necrotic) – the integrity of the stomach is compromised and nearby tissues and organs are damaged.

The severity of pathological changes is determined by the characteristics of the aggressive substance, its quantity and duration of exposure, the presence of contents in the stomach. An important role belongs to the timely provision of first aid.

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Forms

Thermal burn of the stomach is caused by liquid substances heated to boiling point (boiling water, hot oil) getting into it. It is quite rare. First aid consists of cooling the burned mucous membranes - it is necessary for the victim to drink at least a liter of cooled liquid (it is possible with ice).

First-degree thermal burns do not necessarily require hospital treatment; competent care from relatives may be sufficient, and salty, spicy, and smoked foods are excluded from the patient's diet. However, second-degree and, of course, third-fourth-degree injuries require mandatory medical supervision.

A chemical burn of the stomach is caused by liquids, such as acid or alkali, that corrode the epithelium and deeper tissues of the organ walls.

Concentrated acid, getting on the mucous membrane, forms coagulation (dry) necrosis, protecting tissues from its further penetration. If it is known for sure that it is acid that got inside, the patient is given an alkaline solution prepared as follows: dissolve a teaspoon of baking soda in a liter of filtered (boiled) not cold water. Then induce vomiting.

The penetration of alkaline substances causes colliquative (wet) necrosis due to the dissolution of protein and saponification of fat, so they freely penetrate deeper and cause more serious damage. But an insignificant amount of alkali that gets into the stomach is neutralized by the acid there.

If it is known for sure that it is alkali that has entered the body, the patient is given an acid solution. A little acid (acetic, tartaric or citric) is added to a liter of cool boiled water. Then vomiting is induced.

A stomach burn with alcohol, like an acid burn, causes coagulation necrosis, which prevents the spread of damage. A stomach burn with alcohol is manifested by a typical pain syndrome, loss of taste, weakness and dizziness. First aid is gastric lavage. With such a burn, a complete recovery is usually predicted.

Potassium permanganate solution is used internally in cases of poisoning only strained and pale pink. Otherwise, if unstrained particles or its high concentration get in, it can cause a burn of the stomach with potassium permanganate, which leads to dyspeptic phenomena; there is a risk of mechanical asphyxia due to laryngeal edema and shock.

The symptoms are as follows: dark brown color of the mucous membrane of the mouth and throat and its swelling, in the mouth - severe burning, pain in the sternum and epigastric zone. Brown spots (burns) may appear on the skin of the face, neck, chest.

Shortness of breath to the point of suffocation, cyanotic skin and mucous membranes, bloody diarrhea, shaking paralysis.

In severe cases – convulsions, burn shock, acute liver and kidney dysfunction (toxic hepatitis, jaundice, anuria, uremia), collapse. Pregnancy may end in miscarriage.

First of all, the stomach is washed with rinsing the mouth and throat with a solution: for two liters of water - 100 g of three percent hydrogen peroxide and 200 g of three percent vinegar. Rinsing is done until the wash water is completely discolored. The oral cavity, gums and tongue are wiped with a napkin soaked in the same solution. An ambulance is definitely called.

A stomach burn from 6-9% vinegar occurs when accidentally swallowed. The severity is proportional to the volume of vinegar swallowed. Ingestion of one or two sips usually leads to a minor burn of the esophagus, which passes on its own and without consequences. If you swallow more than 50 g, then in addition to significant burn manifestations, poisoning is likely - absorbed in the stomach and intestines, vinegar enters the blood and destroys the membranes of red blood cells. Released from them, hemoglobin disrupts microcirculation of blood in the kidneys, disrupting their function. Renal failure leads to intoxication and dysfunction of the liver. The consequence of consuming 200 g of vinegar or more can be the death of the victim.

Ingestion of vinegar essence (70%) or laboratory acetic acid (98%) causes deep, large-area damage to the upper digestive organs. The victim may die immediately from traumatic shock. If he survives, tissue and internal organ damage is guaranteed. With successful long-term surgical and conservative treatment, complete recovery usually does not occur.

First aid for ingesting concentrated acetic acid is to rinse the mouth and throat with water, preferably with a weak soda solution. Give the victim a chilled liquid to drink (at least a liter of water or milk, possibly with ice) and seek medical help. Before the ambulance team arrives, ensure that the injured person rests, do not wash the stomach with a soda solution or induce vomiting - this can lead to perforation of the esophageal lining.

If you accidentally swallowed just a little bit, you can try to get by with home measures - gargling, gastric lavage, drinking plenty of fluids (water or milk). However, if you experience pain, weakness, nervous excitement or, conversely, lethargy, you must urgently seek medical help.

Disruption of physiological processes can lead to the release of bile into the stomach and provoke a stomach burn with bile. A single case of bile in the stomach should be alarming, but lifestyle adjustments and diet will help prevent relapses. Bile in the stomach can be eliminated with antacid drugs.

If you constantly feel bile in your stomach, you should see a doctor. The main signs of its presence in the stomach are pain, a feeling of heaviness and distension in the abdomen without a specific location, belching, heartburn, and a yellowish coating on the tongue.

Complications and consequences

The consequences and complications of a stomach burn can be quite serious. In case of extensive damage that does not immediately lead to the death of the victim, irreversible changes occur in the internal organs, significantly worsening the prognosis and course of the disease. All layers of the stomach wall tissue can become necrotic, which causes its perforation, most often in the prepyloric zone, and peritonitis. Intoxication with tissue decay products leads to acute liver and/or kidney failure, infection of nearby organs.

The rejection of the scab after an acid burn can cause gastric bleeding, scarring of the walls leads to a narrowing of the lumen of the pylorus and can lead to obstruction in this section. This complication of a chemical burn of the stomach, requiring surgical intervention, develops in approximately 70% of cases of necrotic burns.

Chemical burns of the stomach are often complicated by pulmonary edema, and the patient’s life is constantly in danger.

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Diagnostics stomach burn

Based on the survey of the patient or his relatives, an anamnesis is compiled, the main indicators of the physiological state are considered, focusing on the work of the respiratory organs, fever, symptoms of peritoneal irritation indicating perforation of the stomach.

Tests are done according to indications; upon admission to hospital – a general blood test.

Instrumental diagnostics are used to assess the extent of tissue damage. X-ray examination of the stomach consists of transillumination and serial radiography; contrast is usually not used at first (except in cases where perforation of the stomach wall is suspected). Burn complications are diagnosed 5-6 weeks after the burn – with the help of radiography, deformations and cicatricial constrictions can be determined.

Endoscopy with a thin flexible endoscope (less than 10 mm in diameter) is indicated immediately after the injury. If there is a suspicion of gastric perforation (clinical or radiographic), endoscopic examination is not performed.

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Differential diagnosis

Differential diagnostics in the first day after a burn is carried out in cases where the burn reagent has not been identified, to determine it (based on the medical history, X-ray examination, esophagogastroscopy).

If a gastric burn is complicated by pyloric stenosis or a more extensive pathology, deviations from the norm of blood test parameters are observed. A clinical blood test shows the presence of anemia, inflammation, dehydration; a biochemical test shows a decrease in the content of proteins, sodium, chlorine, potassium, calcium, and sometimes iron.

An electrocardiogram shows diffuse changes in the myocardium. The diagnosis is clarified using X-ray examination, esophagogastroduodenoscopy, ultrasound diagnostics, and electrogastroenterography. If the diagnosis is confirmed, only surgical treatment is possible. Differential diagnostics of complications is carried out with cicatricial ulcerative strictures in the prepyloric zone. Later, if there are scars, the consequences of a burn are differentiated from neoplasms.

Treatment stomach burn

Catarrhal injury does not require medical treatment, but it is advisable to see a doctor to clarify the diagnosis and prevent complications. In case of a more severe burn, specialized medical care is necessary. The further prognosis for recovery, and sometimes the life of the victim, depends on how quickly it is received.

In case of a stomach burn from boiling water, the first aid is plenty of cold liquid (water or milk) and rest.

If a chemical aggressor is ingested, the injured person needs specialized medical care. The ambulance team that arrives on call usually uses a gastric lavage tube, which is unpleasant but quite effective.

Treatment of stomach burns is based on the following principles:

• prescribing analgesics to relieve pain;
• prescribing antispasmodic and sedative drugs;
• maintaining normal functions of the heart, respiratory and excretory organs;
• measures to bring the patient out of a state of shock;
• elimination and/or prevention of intoxication.

The doctor prescribes therapeutic treatment regimens individually, according to the clinical manifestations of the development of pathological processes.

The fundamental modern method of combating the consequences of chemical burns of II-IV degree is endoscopic laser photostimulation, in combination with the prescription of drugs that relieve pain, intoxication, inflammation, increase tissue resistance to oxygen deficiency and prevent the development of infection. Endoscopic laser photostimulation is irradiation of the burned mucous membranes of the esophagus and stomach with a low-energy laser (laser radiation with a wavelength of 0.63 μm at a power density of 10-100 mW). Such treatment allows to reduce the incidence of cicatricial stenosis of the stomach.

An even more promising method of treatment is considered to be endoscopic laser photostimulation with preliminary administration of Mexidol, which enhances its effect due to the fact that laser irradiation helps improve blood microcirculation at the site of exposure.

Mexidol has an active effect that prevents tissue hypoxia. It increases resistance to conditions associated with insufficient oxygenation, including shock, and reduces toxic effects. It is used for intramuscular or intravenous injections. The duration of therapy and dosage selection are proportional to the severity of the patient's condition. The daily dosage is no more than 0.8 g. As a rule, patients tolerate Mexidol well. Nausea and dry mouth are occasionally possible.

Contraindicated in cases of liver and kidney failure, history of allergy to vitamin B6.

To prevent secondary infection, antibiotics are prescribed, for example, Cefazolin, which has a wide spectrum of antimicrobial action. The effect is based on disruption of the process of building the bacterial cell membrane. The drug is used for intramuscular and intravenous injections. Like all antibiotics, it has side effects and is contraindicated in case of allergy to drugs of the cephalosporin group.

Pain relief is provided by both non-narcotic and narcotic analgesics, such as Omnopon, a complex drug consisting of three narcotic analgesics (morphine, codeine, thebaine) and papaverine, which prevents spastic contractions of the smooth muscles of the intestine. It inhibits any pain sensations without turning off consciousness, while maintaining other sensations.

Patients are prescribed subcutaneous injections at a dosage of 10 mg of the drug three to four times a day.

May cause nausea, vomiting, respiratory depression. Long-term use causes drug addiction.
Contraindicated in respiratory dysfunction, dystrophy, elderly patients.

To prevent thrombohemorrhagic syndrome in the burn area, Heparin is prescribed, an anticoagulant that directly affects blood coagulation factors, blocking thrombin biosynthesis; reducing thrombus formation. Activates the ability of blood to dissolve clots, improves blood circulation in the coronary arteries. The method of administration and dosage of heparin is calculated individually. When using this drug, the likelihood of bleeding must be taken into account.

Hormonal therapy is suggested for early prevention of gastric stenosis, however, this is a more than controversial issue. Not all authors agree with the need to prescribe glucocorticoids, the risk of their use associated with side effects (suppression of immunity, therefore, inhibition of the healing process, masking of signs of perforation and infection) exceeds the benefits, so it is better not to use them.

According to indications, medications are prescribed to maintain the normal functioning of the heart muscle and kidneys, respiratory organs, fat-hormonal mixtures to accelerate the reparation of the gastric epithelium, and weakly alkaline mineral waters.

Drug therapy is supplemented by the administration of B vitamins (B6 and B12) intramuscularly or subcutaneously and ascorbic acid orally.

Physiotherapeutic treatment for stomach burns is designed to compensate for insufficient oxygenation of the burned areas (hyperbaric oxygenation).

Laser therapy and high-intensity pulsed magnetic therapy, which stimulate the reparative processes of damaged tissues, may be useful.

Traditional medicine recommends oral intake of vegetable oil for burns of the esophagus and stomach. Moreover, official medicine also includes it in the complex treatment of such injuries. Every morning before eating, you need to swallow a tablespoon of sunflower, olive or sea buckthorn oil.

Folk treatment with eggnog, which has enveloping and soothing properties, gives a good effect. Eggnog should be consumed three times a day. It is easy to prepare - beat two raw yolks with sugar. Alternatively, you can dilute it with a glass of slightly warm milk. In general, it is good to drink fresh milk - 3-5 times a day.

Propolis has good regenerating and immune-boosting properties:

• take 100 ml of vegetable oil (sunflower, olive) and 20 g of propolis, boil in a water bath, stirring regularly with a wooden spoon, after an hour - strain, cool and put in the refrigerator, take a tablespoon three times a day;
• propolis milk – boil half a liter of milk in an enamel saucepan, add 40 g of propolis, stir and leave for a quarter of an hour at a temperature of about 80 ° C on low heat or in the oven, strain, cool; remove the hardened wax from the surface, take one dessert spoon on an empty stomach, have breakfast after 20 minutes.

At home, you can use herbal treatment. To restore the epithelial surface of the stomach, drink an infusion of medicinal chamomile flowers: brew in a thermos at the rate of five teaspoons per half a liter of water, drink instead of tea twice or three times a day.

You can make a slimy drink from flax or quince seeds by pouring 10g of seeds with a glass of boiling water and shaking the mixture for 15 minutes. Let it cool, strain and drink before meals.

Marshmallow root extract promotes cell renewal and improves blood circulation: pour 250 ml of cold boiled water over two teaspoons of crushed marshmallow root, leave for 30 minutes, stirring occasionally. Shake, strain and warm up a little. Take after meals throughout the day in small sips.

Treatment of stomach burns with homeopathic preparations should be carried out strictly individually as prescribed by a homeopathic doctor and under his supervision. Homeopathy offers preparations that prevent excessive scarring and stenosis of the stomach, for example, Calcarea fluorica. This preparation can promote the resorption of the existing narrowing of the pyloric section of the stomach. In case of cicatricial stenosis of the pylorus, Alumina (Alumina), Antimonium crudum (Antimonium crudum) are used, however, all indications have a reservation: "if surgical intervention is not recommended". The preparation Cantharis (Cantaris) can be used for diseases of the gastrointestinal tract, accompanied by burning pain. It is used for severe burns with blisters of any localization. Mancinella (Mancinella) accelerates the restoration of the wound surface of any origin.

Correctly prescribed homeopathic medicines can bring unconditional benefit, however, it is unlikely that they will replace surgery, but recovery after surgery is quite possible.

Surgical treatment

The result of burn injuries that have affected a large area and deep layers of tissue may be pyloric stenosis of the stomach or its complete dysfunction, and as a consequence – dehydration and dystrophy of the patient.

Mostly, a stomach burn is combined with an esophageal burn. Often, the result of the esophageal bougienage procedure is the detection of pathological changes in the stomach.

If bougienage is not possible, a laparotomy is performed, during which the nature of gastric pathologies and the course of further treatment are determined.

In cases of local damage to the stomach (pyloric stenosis), drainage is restored by placing a gastrostomy. As a rule, resection is performed - surgical removal of the part of the stomach in which patency is impaired.

In case of total gastric burn or in the acute period, jejunostomy (imposition of a fistula on the jejunum) is performed to ensure nutrition of the patient. Subsequently, an operation to reconstruct the stomach is performed.

Modern surgical techniques make it possible to restore the functions of the upper digestive tract after a burn.

Prevention

It follows from the above that safety precautions should not be neglected when in contact with unknown or aggressive liquids. It is also necessary to observe safety precautions when storing household chemicals, paints and varnishes, alcohol-containing and other similar substances:

• store them in their original packaging with labels;
• separate from food products;
• in places inaccessible to small children.

In conversations with children, explain the dangers of chemicals and the possibility and consequences of poisoning and burns.

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Forecast

First and second degree burns usually end in recovery, the treatment lasts from ten days to a month. Third and fourth degree burns – full recovery is impossible, the victim loses, at best, part of the stomach. Such injuries can be fatal.