Effectiveness of Methylprednisolone to Prevent Esophageal Stricture Formation after Corrosive Ingestion: A Randomized Control Trial in a Tertiary Medical College of Bangladesh

Background: Corrosive poisoning is a common emergency that can lead to esophageal stricture. Conventional therapeutic methods struggle to prevent this phenomenon. Our study examined whether high-dose Methylprednisolone could reduce esophageal stricture development. Study objective was to evaluate the effectiveness and safety of IV Methylprednisolone in preventing esophageal stricture formation in patients with corrosive ingestions.

Methods: This was a randomized controlled trial conducted in Chittagong Medical College Hospital (CMCH) from January to December, 2018.  51 patients with grade 2a and 2b corrosive esophageal injury, diagnosed by upper GI endoscopy within 48 hours of injury, were selected for this study. The control group (n=26) received conventional treatment alone and the study group (n=25) received high dose of Methylprednisolone (MP) along with conventional treatment (IV Methylprednisolone 1gm/1.73m2 /day for 3 days). Patients were followed up after 4 weeks.

Result: The median age of the participants was 22 years . Most of them (78.4%)  were female. Harpic (72.5%) was the most common corrosive agent used by the patients. Patient went through follow-up after 1 month. None of the patients of the study group developed any stricture. Although 2 (9.1%)  patients of the control group developed it. This difference was not statistically significant (P=0.28).  2 (8.7%) patients in the study group and in 6 (27.3%) patients in the control group developed gastric outlet obstruction which was also not statistically significant (P=0.22). Transient hyperglycemia was observed only in 2 (8%) patients in the study group.

Conclusion: This study concluded that methylprednisolone in high doses did not seem to effectively reduce stricture formation following corrosive ingestion.