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Acquired noncaustic esophageal strictures in children
Elif Sag1, Aysenur Bahadir2, Mustafa Imamoglu3
1Department of Pediatric Gastroenterology Hepatology and Nutrition, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
Insights
Acquired noncaustic esophageal stricture (ES) is rare in children, often presenting with dysphagia and malnutrition. Early identification of these symptoms and associated conditions is crucial for timely diagnosis and management.
Area of Science:
- Pediatric Gastroenterology
- Esophageal Diseases
- Clinical Pediatrics
Background:
- Esophageal stricture (ES) is an uncommon pediatric condition, with acquired noncaustic ES being particularly rare.
- Clinical features and outcomes of acquired noncaustic ES in children are not well-defined.
Purpose of the Study:
- To evaluate the clinical findings and outcomes of pediatric patients diagnosed with acquired noncaustic ES.
- To assist physicians in the early referral of at-risk children to gastroenterology specialists.
Main Methods:
- Retrospective review of medical data for pediatric patients with acquired noncaustic ES.
- Data collected from patients seen in a gastroenterology clinic between January 2009 and December 2019.
Main Results:
- Acquired noncaustic ES occurred in 0.24% of pediatric endoscopy patients (12/4,950).
- Key symptoms included dysphagia (58.3%) and vomiting (33.3%); 66.6% experienced malnutrition.
- Etiologies included radiotherapy, peptic reflux, achalasia, chemotherapy, squamous-cell carcinoma, eosinophilic esophagitis, and epidermolysis bullosa.
Conclusions:
- Solid dysphagia, malnutrition, and co-existing diseases are potential indicators of esophageal stricture in children.
- Diverse etiologies necessitate tailored treatment approaches, ranging from endoscopic dilation and medical therapy to surgical interventions.
Background:
Esophageal stricture (ES) is an uncommon clinic entity in pediatrics that may be congenital or acquired in childhood. Acquired noncaustic ES is very rare, and clinical features of affected patients are unknown.
Purpose:
We aimed to evaluate the clinical findings, and outcomes of patients with acquired noncaustic ES to aid physicians in the early referral of patients to gastroenterologists.
Methods:
The medical data of patients with acquired noncaustic ES who were followed in our gastroenterology clinic between January 2009 and December 2019 were reviewed.
Results:
Acquired noncaustic ES was found in 12 of the 4,950 patients (0.24%) who underwent endoscopy during the study period. The main symptoms were dysphagia (58.3%), vomiting (33.3%), and chronic anemia (8.3%). Chronic malnutrition and underweight were found in 66.6% of the patients. The most common etiological factors were radiotherapy, peptic reflux, and achalasia (16.6%, each), while chemotherapy, squamous-cell carcinoma (SC) of the esophagus, eosinophilic esophagitis (EoE), esophageal web, epidermolysis bullosa, and esophageal diverticulum (8.2%, each) were the other etiological factors. Patients with EoE underwent endoscopic bougie dilation in addition to steroid use and elimination diet. Patients with epidermolysis bullosa and esophageal web underwent bougie dilation. Patients with peptic reflux-related ES were initially put on antireflux therapy, but during follow-up, one patient required esophageal replacement with colonic interposition. Patients with radiotherapy-related ES recovered with medical therapy. The patient with initially underwent surgical gastrostomy and tumoral mass excision. The patient then received chemotherapy and radiotherapy and underwent jejunal interposition. Patients with achalasia underwent surgical esophagomyotomy.
Conclusion:
The presence of solid dysphagia, malnutrition, and an associated disease may alert physicians to the presence of ES.
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