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Esophageal Inlet Patch: An Under-Recognized Cause of Symptoms in Children
Giovanni Di Nardo1, Cesare Cremon2, Luca Bertelli2
1Pediatric Unit, Orvieto Hospital, Orvieto, Italy; Pediatric Gastroenterology Unit, International Hospital Salvator Mundi, Rome, Italy.
Insights
Inlet patch (IP) is an under-recognized cause of symptoms in children. Argon plasma coagulation (APC) effectively treats IP-related symptoms when proton pump inhibitors fail, offering a safe therapeutic option.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Endoscopy
- Histopathology
Background:
- Inlet patch (IP) is a common congenital anomaly of the upper gastrointestinal tract.
- Its clinical significance and management in pediatric populations remain under-investigated.
Purpose of the Study:
- To determine the incidence of IP in children.
- To evaluate clinical and pathological features, diagnostic workup, treatment efficacy, and natural history of IP.
Main Methods:
- Prospective enrollment of 1000 pediatric patients undergoing esophagogastroduodenoscopy.
- Biopsy of IPs and surrounding tissues; multichannel intraluminal impedance and pH monitoring (MII-pH) for symptomatic patients.
- Treatment with proton pump inhibitors (PPIs) and argon plasma coagulation (APC) for refractory cases.
Main Results:
- Endoscopic incidence of IP was 6.3%.
- 56% of patients with IP were asymptomatic; 27% had chronic IP-related symptoms.
- APC was effective in treating IP-related symptoms in all patients unresponsive to PPIs, achieving complete remission.
Conclusions:
- IP is an under-recognized cause of pediatric esophageal and respiratory symptoms.
- MII-pH and biopsies are crucial for diagnosis and guiding therapy.
- APC is a safe and effective treatment for symptomatic pediatric IP.
Objectives:
To determine the incidence of inlet patch (IP) and to assess the clinical and pathological features, role of the diagnostic workup in treatment decision making, efficacy of medical and endoscopic therapy, and natural history in a pediatric population.
Study Design:
Consecutive patients aged <18 years (n = 1000) undergoing esophagogastroduodenoscopy were enrolled prospectively. Biopsy specimens were obtained from IPs and the proximal and distal esophagus, stomach, and duodenum. Multichannel intraluminal impedance and pH monitoring (MII-pH) was performed in all symptomatic patients. Symptomatic patients were treated with proton pump inhibitors for 8 weeks, and IP ablation by argon plasma coagulation (APC) was performed in unresponsive patients.
Results:
The endoscopic incidence of IP was 6.3%, with a cumulative missing rate of 5.8%. Thirty-five of the 63 patients (56%) were asymptomatic, 11 (17%) had symptoms clearly related to the underlying digestive disorder, and 17 (27%) had chronic IP-related symptoms. MII-pH was positive in 10 of the 28 symptomatic patients. All 17 patients with IP-related symptoms were unresponsive to proton pump inhibitors and were treated with APC, and all had achieved complete remission by the 3-year follow-up. Patients with underlying disorders were successfully treated with medical therapy, and asymptomatic patients remained symptom-free, with no endoscopic or histological changes seen at the 3-year follow-up.
Conclusion:
IP is an under-recognized cause of symptoms in children with unexplained esophageal and respiratory symptoms. MII-pH and bioptic sampling are needed to exclude entities mimicking IP symptoms and to direct therapy. APC is safe and effective for treating IP-related symptoms.
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