Role of high‑dose methylprednisolone in Zargar Grade IIB corrosive esophageal burns: A randomized control study
Irtiqa Sheikh1
, Nayer Jamshed1, Akhil Neseem1, Praveen Aggarwal1, Saurabh Kedia2, Maroof Ahmad Khan3, Chandan J. Das4, Ankit Kumar Sahu1
1Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
2Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
3Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
4Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
Keywords: Airway injury, corrosive ingestion, esophageal burns, steroids, stricture, Zargar classification
Abstract
OBJECTIVE: The objective of the study is to test the efficacy of high dose methylprednisolone in the prevention of esophageal stricture after corrosive ingestion.
METHODS: This study was a single center, randomized controlled single blinded study. Simple randomization was done with 15 adult patients (>18 years) in each arm, who presented with a history of corrosive ingestion within the past 24 h and had esophageal injury of Zargar Grade IIB on endoscopy. Intravenous methylprednisolone 1 g/day for 3 days was given to the intervention arm while 100 mL of normal saline was given as placebo in control arm. Follow up to diagnose esophageal stricture was done at 8 weeks.
RESULTS: Thirty patients (15 in each arm) were recruited for the study. As per the intention to treat analysis, 33% and 46.6% developed stricture in the intervention and control arm, respectively (relative risk [RR] = 0.714; 95% confidence interval 0.29–1.75; P = 0.462). 40% patients in control group and 7.7% in intervention group had undergone feeding jejunostomy, which was statistically significant with a p-value of 0.048. Airway injury showed significant clinical improvement in the intervention arm but the difference was nonsignificant statistically (P = 0.674). There was no increased incidence of hypertension, hyperglycemia, hyponatremia, hyperkalemia, or infections in intervention arm.
CONCLUSION: Methylprednisolone does not help in the prevention of stricture formation in corrosive esophageal injury, but it significantly reduces the requirement of feeding jejunostomy and has a beneficial role in treating airway injury.
How to cite this article: Sheikh I, Jamshed N, Neseem A, Aggarwal P, Kedia S, Khan MA, et al. Role of high-dose methylprednisolone in Zargar Grade IIB corrosive esophageal burns: A randomized control study. Turk J Emerg Med 2024;24(1):20-6.
The study was approved by Institute Ethics Committee (Ref No: IECPG‑212/June 24, 2020) on June 25, 2020, and the protocol was registered with the National Clinical Trial Registry (CTRI/2020/09/027532).
• IS: Methodology, Investigation, Data curation, Formal analysis, Writing Original Draft, Visualization
• NJ: Conceptualization, Data curation, Methodology, Writing Review and Editing, Visualization, Supervision
• AN: Investigation, Writing Original Draft, Review and Editing, Data curation
• PA: Conceptualization, Supervision, Resources
• SK: Data curation, Supervision, Project administration, Resources
• MK Formal analysis, Project administration, Resources
• CJD: Methodology, Supervision, Project administration
• AK: Formal analysis, Writing Review and Editing.
None Declared.
None.