Unifying Concepts

Classification of Caustic-Induced Gastrointestinal Injuries

Caustic substances injure tissue by means of a chemical reaction on direct physical contact. Often thought of as acids or bases, caustics broadly include desiccants, vesicants, and protoplasmic poisons. The term “corrosive” is often used interchangeably with “caustic,” but corrosion implies a mechanical degradation, which does not always apply to caustics.
Caustics are present at home and in industry. They cause injury after dermal, ocular, or gastrointestinal contact. In western countries, commonly ingested household caustics include lye (sodium or potassium hydroxide) found in drain cleaners and hair relaxers, bleach (sodium hypochlorite) or ammonia (ammonium hydroxide) found in cleaning products, and highly concentrated acids (e.g., hydrochloric acid) found in toilet bowl or swimming pool cleaners. In other countries, concentrated acids such as hydrochloric, nitric, and sulfuric acids are commonly found in homes.
An increase has been reported in caustic-induced injuries in children resulting from ingestion of the contents of laundry-detergent capsules (water-soluble membranes, commonly called pods, containing liquid detergent that is more concentrated than traditional liquid or powdered laundry detergents).

Classification of Caustic-Induced Gastrointestinal Injuries

Grade Findings Prognosis
0 Normal Complete recovery
1 Edema and erythema Complete recovery
2A Friability, hemorrhage, and superficial ulcerations Stricture unlikely
2B Deep ulcerations (either discrete or circumferential), in addition to friability, hemorrhage, and superficial ulcerations High risk of stricture, low risk of perforation
3A Small, scattered areas of necrosis High risk of stricture, greater risk of perforation than with grade 2B injury
3B Extensive necrosis High risk of perforation and strictures
4 Perforation Often fatal



  1. Hoffman RS, Burns MM, Gosselin S. Ingestion of Caustic Substances. N Engl J Med. 2020;382(18):1739‐1748. [Medline]
  2. Hall AH, Jacquemin D, Henny D, Mathieu L, Josset P, Meyer B. Corrosive substances ingestion: a review. Crit Rev Toxicol. 2019;49(8):637‐669. [Medline]


Created May 26, 2020.

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