Evolving diagnostic and therapeutic methods in corrosive esophagitis: Evaluation of a diagnostic and therapeutic algorithm based on 26 years of experience.

Background: Corrosive esophagitis caused by ingestion of acidic or alkaline substances remains a serious public health issue, especially in developing countries. Despite numerous studies, there is currently no universally accepted treatment algorithm for corrosive esophagitis. This study aims to present a diagnostic and treatment algorithm developed from 26 years of clinical experience and to evaluate current management approaches. Methods: In this retrospective study, patients diagnosed with corrosive esophagitis and admitted to a tertiary thoracic surgery clinic between January 1998 and December 2024 were analyzed. Demographic data, ingested substance type and intent (accidental or suicidal), clinical presentation, diagnostic methods, treatment strategies, and outcomes were evaluated. Endoscopic injury severity was classified using the Zargar system. As this was a descriptive study, no statistical testing was performed. Results: A total of 501 patients were included. Commonly ingested substances were bleach, limescale removers, and detergents. Rigid esophagoscopy was performed in 248 patients (49.5%) and classified using Zargar grades. Oral intake was initiated based on symptoms and injury severity, with a mean of 4.5±5.23 days. All patients received intravenous proton pump inhibitors and antibiotics; corticosteroids were selectively used. Surgery was required in 3 patients due to complications such as perforation and fibrosis, and 8 underwent dilatation for strictures. Four patients (0.8%) died due to airway injury, suicide, or cardiopulmonary arrest. Conclusion: Corrosive esophagitis remains a diagnostic and therapeutic challenge. A symptom- and imaging-based triage approach may guide safe management. Routine corticosteroid use appears unnecessary. The proposed algorithm, based on 26 years of clinical experience, may serve as a practical tool to streamline management and improve patient outcomes.