[Treatment policy for children with gastroesophageal reflux complicated by Barrett esophagus]

Barret's esophagus (BE) is a rare disease in children. It is caused by gastroesophageal reflux (GER). From 1996 to 1999 seventy-eighth children with GER were treated. Twenty-four-hour pH-metry and manometry of the esophagus, scintigraphy and contrast roentgenoscopy of the esophagus were used for diagnosis of GER. All the children underwent biopsy of mucosa membrane of distal esophagus. Morphologic examinations revealed BE in 16 (20.5%) children. Metaplasia of esophageal epithelium by intestinal type (IT) in combination with one by gastric type (GT) were revealed in 8 children, metaplasia by gastric type alone (epithelium of gastric and fundal parts of the stomach)--in 8 children. Six children with IT metaplasia of the esophagus with long strictures underwent extirpation of the esophagus with one-stage esophagoplasty. It esophageal stenosis is not long or is absent, fundoplication by Nissen (4 children) and drug therapy (6 children) are performed. It is concluded that in IT metaplasia of the esophagus with long peptic esophageal strictures resistant to bouginage extirpation of the esophagus with one-stage coloesophagoplasty is desirable. Other methods of treatment do not exclude probability of esophageal adenocarcinoma. These children should be followed up with esophageal biopsy each 6-12 months.