Response to Quitadamo et al.

We read with interest the article by Quitadamo et al., which provides us with data that most pediatric household bleach ingestions are benign.1 It would be interesting to see if their data align with findings previously reported by Crain et al.2 which showed that vomiting and drooling together, or stridor alone, were associated with higher risk of clinically significant esophageal injury. These findings from over 40 years ago continue to provide guidance to clinicians today regarding the evaluation of children with caustic ingestions.3 We posit that a post hoc analysis of the data by Quitadamo et al., paying close attention to vomiting and drooling combined, or stridor alone, could yield findings that align with those reported by Crain et al., validating a decades-old landmark study. Furthermore, the Quitadamo study could also inform guidelines on performing esophagogastroduodenoscopy (EGD) for symptomatic pediatric patients following caustic ingestions. Current European society guidelines for pediatric caustic ingestions recommend EGD for children with “any symptoms,” and Italian society guidelines recommend EGD for “symptomatic children” or in “those with a documented caustic ingestion, regardless of symptoms.”4, 5 Both of these guidelines may result in unnecessary EGDs, a procedure which does not come without risk and potential complications. The findings by Quitadamo provide evidence that symptomatic children with certain caustic ingestions do not need EGD, and further risk stratification should rather be focused on specific symptoms (or combination of symptoms) and clinical findings to determine their association with clinically significant esophageal injury. The authors declare no conflicts of interest. None.