Which of the following statement(s) is/are true concerning caustic injury to the esophagus?

a. Alkaline injury is more destructive than acid injury

b. Acid ingestion is not injurious to the stomach due to its normal acidic pH

e. Children are less likely to form a late esophageal stricture than adults 

Caustic injury occurs in two broad categories of patients, children younger than 5 years of age who accidentally swallow these agents, and adults who are attempting suicide. The most common agents responsible for caustic esophageal injuries are alkalis, acids, bleach and detergents. Ingestion of detergents and bleaches virtually always cause only mild esophageal irritation which heals without significant adverse sequelae. Acids and alkalis may have devastating effects which range from acute multi-organ necrosis and perforation to chronic esophageal and gastric strictures. Alkalis are more destructive, producing liquefaction and necrosis which almost insures deep penetration whereas acids usually cause coagulation necrosis that, in part, limits the depth of injury. Liquid alkali preparations have prolonged contact with the mucosa of the esophagus and stomach due to its high viscosity. In addition, ingested acids typically pass through the esophagus quickly, producing major gastric injury with relative sparing of the esophagus. In response to either ingested acid or alkali, reflex pyloric spasm occurs, with resultant pooling of these agents in the gastric antrum. The clinical manifestations of caustic ingestion are directly related to the amount and character of the agent ingested. When esophageal or gastric perforation results from caustic ingestion, patients demonstrate progressive severe sepsis and hypovolemic shock until appropriate resuscitative measures are instituted. In the absence of gastric or esophageal perforation, the acute clinical manifestations typically resolve within days, with clinical improvement lasting for weeks. After this, symptoms due to either esophageal or gastric stricture begin to form. Most adults who ingest liquid alkali will develop severe esophageal and usually gastric injury that results in stricture formation. Children, with usually more limited exposure from accidental ingestions, are less likely to have severe injuries.