Effect of Chlorine Bleach on the Esophagus

The stimulus for this review and study was the report of experimentally produced esophageal burns in animals secondary to Clorox® ingestion which was reported by previous investigators in Chicago. Twenty-six children have been admitted to Children's Memorial Hospital since 1969 with “bleach ingestion” as the diagnosis. All but six underwent esophagoscopy in compliance with a “Pediatrics-Otorhinolaryngology Study Protocol” in an attempt to diagnose esophageal burns. Chemical burn of the esophagus was found in only one case; however, the exact content of ingested material was not definitely identified. In the one case of chemical burn, treatment was performed per protocol, and the patient is free of symptoms of stricture eighteen months postingestion. None of the other twenty-five patients have returned for treatment of ingestion sequelae. A laboratory study was conducted which utilized cats to simulate Clorox® ingestion by children. The cats were sacrificed at varying periods of time following ingestion with gross and microscopic exam of each esophagus being performed. Results showed the potential of chlorine bleach to cause chemical burns and superficial ulceration, but no stricture or residual sequelae when ingested in a manner simulating physiologic swallowing. Appropriate conclusions were made in respect to treatment of future patients with the diagnosis of “bleach ingestion.”