The most common chemical injury to the esophagus follows the ingestion of lye or other strong alkalies; less commonly, injury follows the ingestion of strong acids. The type and amount of chemical ingested determine the severity and location of the damage.

In children, household chemical ingestion is accidental; in adults, it’s usually a suicide attempt or gesture. (See Advice for corrosive esophagitis, page 314.) The chemical may damage only the mucosa or submucosa, or it may damage all layers of the esophagus.

Esophageal tissue damage occurs in three phases: in the acute phase, edema and inflammation; in the latent phase, ulceration, exudation, and tissue sloughing; and in the chronic phase, diffuse scarring.

Effects vary from none to intense pain in the mouth and anterior chest,
marked salivation, inability to swallow, and tachypnea. Bloody vomitus that contains pieces of esophageal tissue signals severe damage. Signs of esophageal perforation and mediastinitis, especially crepitation, indicate destruction of the entire esophagus. Inability to speak suggests laryngeal damage.