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The role of gastroesophageal reflux in pediatric dysphagia
A G Catto-Smith1, H Machida, J D Butzner
1Department of Pediatrics, Alberta Children's Hospital, Canada.
Insights
Pediatric dysphagia, or food-sticking, can be a primary symptom of reflux esophagitis. Many children with this condition show no prior signs of gastroesophageal reflux but improve with treatment.
Area of Science:
- Pediatric Gastroenterology
- Esophageal Disorders
Background:
- Dysphagia, commonly known as food-sticking, is a significant symptom in pediatric patients.
- Identifying the underlying causes of dysphagia is crucial for effective treatment.
Purpose of the Study:
- To investigate the relationship between dysphagia and reflux esophagitis in children.
- To determine if dysphagia can present without typical gastroesophageal reflux symptoms.
Main Methods:
- Retrospective review of 16 pediatric patients presenting with dysphagia.
- Utilized upper gastrointestinal series, esophageal manometry, 24-h pH monitoring, endoscopy, and biopsy.
- Assessed clinical response to antireflux therapy.
Main Results:
- 12 out of 16 children had histologic evidence of reflux esophagitis.
- Only five children reported symptoms suggestive of gastroesophageal reflux.
- All patients receiving antireflux therapy showed clinical improvement.
Conclusions:
- Dysphagia in children can be an initial indicator of reflux esophagitis, even without a history of gastroesophageal reflux.
- Reflux esophagitis should be considered in the differential diagnosis of pediatric dysphagia.
- Antireflux therapy is effective in managing dysphagia associated with reflux esophagitis.
Abstract:
The history, physical examination, and the results of the upper gastrointestinal series, esophageal manometry, 24-h pH recording, endoscopy, and biopsy are reviewed in 16 children (mean age of 10.6 years, range of 3 years 5 months to 15 years 3 months) who presented to the Alberta Children's Hospital with dysphagia ("food-sticking") without previously identified provocative disorders since January 1985. Of the 16 patients, 11 had had intermittent obstruction, and 7 had had intervention to relieve obstruction (2 Heimlich maneuvers, 1 intravenous glucagon, and 4 endoscopy after failure of intravenous glucagon). Although only five children had a recent history suggestive of gastroesophageal reflux, 12 had histologic evidence of reflux esophagitis (including 1 with a peptic stricture, 1 with "nutcracker" esophagus, and 1 with esophageal dysmotility characteristic of Down's syndrome) and all responded clinically to antireflux therapy. Of the remaining four patients, one had extrinsic esophageal compression from a vascular ring (right aortic arch with left ligamentum arteriosum), one had a single and another had recurrent episodes of food-sticking without any identified abnormality, and one declined investigation. In childhood, dysphagia may be the presenting symptom of reflux esophagitis in the absence of a history suggestive of gastroesophageal reflux and without evidence of a peptic stricture.