What is the immediate management for a patient presenting with esophageal abrasion in the emergency department?

From the Guidelines

The immediate management of esophageal abrasion in the emergency department should focus on pain control, preventing complications, and addressing the underlying cause, with initial treatment including analgesics, proton pump inhibitors, and maintaining NPO status, as recommended by the WSES guidelines 1. The management of esophageal abrasion involves several key components, including:

• Pain control: Administering analgesics such as liquid lidocaine (viscous lidocaine 2%, 10-15 mL swished and swallowed every 4-6 hours) to provide topical pain relief, along with systemic pain management using NSAIDs or opioids if needed 1.
• Preventing complications: Proton pump inhibitors like omeprazole (40 mg daily) or pantoprazole (40 mg daily) should be started to reduce acid exposure and promote healing, as well as maintaining NPO (nothing by mouth) status initially, gradually advancing to clear liquids and then soft foods as tolerated 1.
• Addressing the underlying cause: Intravenous fluids should be administered to maintain hydration while oral intake is limited, and antibiotics are generally not required unless there are signs of infection or perforation 1.
• Monitoring for complications: Close monitoring for complications such as bleeding, infection, or perforation is essential, with vital signs checked regularly, and patients should be educated about avoiding irritants like alcohol, spicy foods, and acidic beverages during the healing period, which typically takes 7-10 days for uncomplicated cases 1. It is essential to note that the management of esophageal abrasion should be tailored to the individual patient's needs and circumstances, and that the WSES guidelines provide a comprehensive framework for the management of esophageal emergencies 1.

From the Research

Immediate Management for Esophageal Abrasion

The immediate management for a patient presenting with esophageal abrasion in the emergency department involves several key considerations:

• Assessment of the patient's symptoms, such as dysphagia, odynophagia, and retrosternal pain, to determine the severity of the esophageal abrasion 2
• Evaluation of the patient's medical history, including any history of gastroesophageal reflux disease (GERD) or use of medications that may irritate the esophagus, such as ibuprofen 2, 3
• Diagnostic testing, such as endoscopy, to confirm the presence of esophageal abrasion and rule out other conditions, such as esophageal perforation 2

Treatment Options

Treatment options for esophageal abrasion may include:

• Proton pump inhibitors, such as omeprazole, to reduce acid production and promote healing of the esophagus 4, 5
• Analgesics, such as acetaminophen or ibuprofen, to manage pain and discomfort, although ibuprofen should be used with caution due to the risk of esophageal perforation 2, 3
• Antibiotics, in cases where there is a high risk of infection, such as in patients with compromised immune systems or those who have undergone esophageal surgery 6

Prevention of Complications

Prevention of complications, such as esophageal perforation or stricture, is critical in the management of esophageal abrasion:

• Patients should be advised to avoid irritants, such as citrus fruits or spicy foods, and to eat small, frequent meals to reduce symptoms 4
• Patients with a history of GERD or esophageal surgery should be closely monitored for signs of complications, such as dysphagia or chest pain 6, 5