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# Caustic ingestion

Swallowing strong alkalis or acids, such as drain or oven cleaners, which burn the mouth, oesophagus and stomach and can cause narrowing or perforation.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Esophagus](https://durgical.com/en/anatomy/esophagus-abdominal-part/)
- [Stomach](https://durgical.com/en/anatomy/stomach/)
- [Pharynx](https://durgical.com/en/anatomy/pharynx/)
- [Epiglottis](https://durgical.com/en/anatomy/epiglottis/)
- [Vocal folds](https://durgical.com/en/anatomy/vocal-fold/)
- [Trachea](https://durgical.com/en/anatomy/trachea/)
- [Duodenum](https://durgical.com/en/anatomy/duodenum/)

## Why it happens

- [Patterns of necrosis: coagulative, liquefactive, caseous, fat, fibrinoid, gangrenous](https://durgical.com/en/general-pathology/patterns-of-necrosis-coagulative-liquefactive-caseous-fat-fibrinoid-gangrenous/)
- [Chemical (toxic) cell injury: direct and after metabolism](https://durgical.com/en/general-pathology/chemical-cell-injury-direct-and-after-metabolism/)
- [Esophagus and the Barrett change](https://durgical.com/en/histology/esophagus-and-the-barrett-change/)
- [The GI tract wall: mucosa, submucosa, muscularis, serosa; enteric plexuses](https://durgical.com/en/histology/the-gi-tract-wall-mucosa-submucosa-muscularis-serosa-enteric-plexuses/)

## What it is

Injury to the upper airway and digestive tract after swallowing corrosive substances: alkalis (lye in drain and oven cleaners, some detergents) or acids (toilet bowl cleaners, battery acid). The depth of the burn determines the risk of perforation in the first days and of oesophageal stricture weeks later; long-term it raises the risk of oesophageal cancer.

## Who gets it

Two groups predominate: small children who accidentally drink household products, often decanted into unlabelled bottles, and adolescents or adults who swallow them intentionally, who have larger, more severe ingestions. In Latin America caustics used for cleaning and informal soap-making are easy to obtain at home.

## Causes

- Alkalis: sodium or potassium hydroxide (drain and oven cleaners), ammonia, concentrated bleach
- Acids: hydrochloric, sulfuric and other acids (toilet and metal cleaners, battery acid)
- Button batteries and dishwasher pods can also cause corrosive injury
- Accidental ingestion in children; intentional ingestion in adolescents and adults

## Risk factors

- Age 1 to 5 years and curious exploration
- Products stored in drink bottles or without child-resistant caps
- Depression and previous self-harm
- Alcohol intoxication or cognitive impairment in adults

## Pathophysiology

Alkalis cause liquefactive necrosis: they saponify fats and dissolve proteins, so they penetrate deeply and injure mainly the oesophagus. Acids cause coagulative necrosis, forming an eschar that limits penetration, and pass quickly to the stomach, especially the antrum and pylorus. Over the first days the tissue sloughs and is weakest (highest perforation risk); fibroblasts then deposit collagen and, from about the third week, the healing burn can contract into strictures.

## Classification

- Zargar endoscopic grading: grade 0 normal; 1 oedema and redness; 2a superficial ulcers; 2b deep or circumferential ulcers; 3a scattered necrosis; 3b extensive necrosis
- By agent: alkali versus acid
- By intent: accidental versus intentional

## Symptoms and signs

- Burns, pain and swelling of lips, mouth and throat
- Drooling and painful or difficult swallowing
- Vomiting, sometimes with blood
- Chest or abdominal pain
- Hoarseness, stridor or difficulty breathing from laryngeal injury
- Absence of mouth burns does not exclude oesophageal injury

## Red flags

- Stridor, hoarseness or respiratory distress (airway oedema)
- Severe chest pain, subcutaneous emphysema or peritonitis (perforation)
- Haematemesis or shock
- Drooling and inability to swallow saliva
- Intentional ingestion of a large volume

## Diagnosis

**Clinical**
History of the product (name, acid or alkali, concentration, amount and time) and examination of the airway, mouth, [chest](https://durgical.com/en/anatomy/region/chest/) and [abdomen](https://durgical.com/en/anatomy/region/abdomen/). Combinations of symptoms such as drooling, vomiting and stridor predict significant injury.

**Tests**
Blood gas, lactate, electrolytes, complete blood count, [kidney](https://durgical.com/en/anatomy/kidney/) function, coagulation and type and screen; paracetamol and salicylate levels in intentional ingestion. Upper endoscopy, ideally within the first 24 hours, grades the injury and guides management.

**Imaging**
Chest and upright abdominal X-rays for free air; CT of chest and abdomen is increasingly used to detect transmural necrosis and perforation. Contrast studies later assess strictures.

## Differential diagnosis

- Foreign body ingestion, including button batteries
- Infectious or pill oesophagitis
- Angioedema or epiglottitis causing drooling and stridor
- Hydrocarbon ingestion with aspiration
- Pesticide poisoning (paraquat) with oral burns

## Goal of treatment

Secure the airway, avoid any manoeuvre that adds injury, grade the burn to decide feeding and surgery, detect perforation early, and prevent or treat strictures while addressing intent.

## Treatment

**Acute**
Airway first: early intubation by an experienced operator if there is stridor or airway oedema; blind nasogastric tubes are avoided. Vomiting is not induced, and neutralising agents and activated charcoal are not used.

**Conservative**
Nil by mouth until endoscopic grading; low-grade burns resume oral intake early, deeper burns may need enteral feeding by a tube placed under endoscopic guidance or parenteral nutrition.

**Medical**
Analgesia, intravenous fluids and acid suppression (proton-pump inhibitors); antibiotics only for perforation or infection. Corticosteroids are not routinely recommended.

**Surgical**
Emergency surgery (resection of necrotic oesophagus or [stomach](https://durgical.com/en/anatomy/stomach/)) for perforation or full-thickness necrosis; later oesophageal dilation, stenting or reconstruction for strictures.

**Follow-up**
Respiratory status, pain, signs of perforation and bleeding in the first days; nutrition and swallowing follow-up for weeks; psychiatric assessment after intentional ingestion and endoscopic surveillance years later for cancer.

## Complications

- Airway oedema and obstruction
- Oesophageal or gastric perforation with mediastinitis or peritonitis
- Upper gastrointestinal bleeding
- Oesophageal stricture and gastric outlet obstruction
- Aspiration pneumonia
- Squamous cell carcinoma of the oesophagus decades later

## Prognosis

Grade 1 and 2a burns usually heal without sequelae. Grade 2b and 3 burns carry high risks of stricture, and extensive necrosis carries substantial mortality from perforation and sepsis. Intentional adult ingestions have the worst outcomes.

## Prevention

- Storing cleaning products in original, labelled containers with child-resistant closures, out of children's reach
- Never decanting chemicals into drink or food bottles
- Regulation of product concentration and packaging, and suicide-prevention programmes

## Test yourself

Think of the answer, then tap the question to see it.

## Which type of necrosis do alkalis cause, and why are they more dangerous for the oesophagus?

Liquefactive necrosis: alkalis saponify fats and penetrate deeply, causing severe oesophageal injury.

## Why are induced vomiting and neutralising agents contraindicated after caustic ingestion?

Vomiting re-exposes the oesophagus and airway, and neutralisation produces heat and further injury.

## What test grades the severity of caustic injury?

Upper endoscopy within about 24 hours, using the Zargar classification.

## When is the oesophageal wall weakest after a caustic burn, and when do strictures appear?

It is weakest during the first days of sloughing; strictures usually develop from about the third week.

## What long-term malignant risk follows caustic oesophageal injury?

Squamous cell carcinoma of the oesophagus, which justifies endoscopic surveillance years later.

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## Related conditions

- [Oesophageal perforation (Boerhaave syndrome)](https://durgical.com/en/conditions/oesophageal-perforation/)
- [Oesophageal cancer](https://durgical.com/en/conditions/oesophageal-cancer/)
- [Upper gastrointestinal bleeding](https://durgical.com/en/conditions/upper-gastrointestinal-bleeding/)
- [Peritonitis](https://durgical.com/en/conditions/peritonitis/)
- [Aspiration pneumonia and pneumonitis](https://durgical.com/en/conditions/aspiration-pneumonia-and-pneumonitis/)
- [Oropharyngeal dysphagia in older adults](https://durgical.com/en/conditions/oropharyngeal-dysphagia-in-older-adults/)
- [Suicidal behaviour and suicide risk](https://durgical.com/en/conditions/suicidal-behaviour-and-suicide-risk/)
- [Paraquat poisoning](https://durgical.com/en/conditions/paraquat-poisoning/)
- [Hydrocarbon ingestion and aspiration](https://durgical.com/en/conditions/hydrocarbon-ingestion-and-aspiration/)
- [Foreign body aspiration in children](https://durgical.com/en/conditions/foreign-body-aspiration-in-children/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Drain opener poisoning](https://medlineplus.gov/ency/article/002780.htm) (MedlinePlus, US National Library of Medicine, 2026).

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/caustic-ingestion/