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Peptic esophageal stricture in children
M Bosheva1, N Chatalbashev, M Pechilkova
1Department of Pediatrics, Higher Medical Institute, Plovdiv, Bulgaria.
Insights
Peptic esophageal stricture in children, a complication of GERD, often requires surgical intervention. Nissen fundoplication is the preferred treatment, offering complete recovery without complications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Gastroesophageal Reflux Disease (GERD)
Background:
- Peptic esophageal stricture affects 5% of children with GERD.
- Diagnosis relies on clinical symptoms, esophagoscopy, pH-metry, and X-ray.
- Initial medical or bougienage treatments often fail.
Observation:
- Six pediatric cases of peptic esophageal stricture were reviewed.
- Patients presented with vomiting, hematemesis, and anemia.
- Nissen fundoplication was performed after failed conservative treatments.
Findings:
- All surgically treated patients achieved complete recovery.
- No postoperative complications were observed in the Nissen fundoplication group.
Implications:
- Nissen fundoplication is the treatment of choice for pediatric peptic strictures.
- Conservative management shows poor results.
- Effective surgical intervention ensures positive patient outcomes.
Introduction:
Peptic esophageal stricture as a complication of gastroesophageal reflux disease (GERD) occurs in 5% of the affected children.
Material And Methods:
Case histories of 6 children treated successfully in the Department of Pediatrics and Clinic of Pediatric Surgery were studied. The diagnosis in each case was based on clinical symptoms (vomiting leading to hypothrophy, hematemesis, and anemia), and esophagoscopy, esophageal pH-metry (according to ESPGAN recommendations), and contrast X-ray examination. After evaluation medical treatment was applied in 3 and bougienage with a hard bougie in 6 patients. Because of failure of this treatment Nissen fundoplication and postoperative bougienage were performed in all patients.
Results:
In all surgically treated patients complete recovery without postoperative complications was achieved.
Discussion:
The authors give interpretation of the pathogenesis and outline the primary symptoms of the disease. Terms of performance and reliability of the instrumental methods of diagnosing are discussed. The experience in treatment of peptic esophageal stricture in children is presented.
Conclusions:
Medical treatment combined with bougienage yields poor results in peptic esophageal stricture and Nissen fundoplication appears to be the treatment of choice.