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Clinical and laboratory correlates of esophagitis in young children
J S Hyams1, A Ricci, A M Leichtner
1Department of Pediatrics, Hartford Hospital, Connecticut 06115.
Insights
Identifying infants with gastroesophageal reflux (GER) at risk for esophagitis is challenging. Current clinical and lab assessments lack value, but severe histologic esophagitis may predict surgical intervention needs.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Pathology
- Clinical Diagnostics
Background:
- Gastroesophageal reflux (GER) is common in infants, often presenting with persistent symptoms.
- Esophagitis, an inflammation of the esophagus, can be a complication of GER.
- Accurate identification of at-risk infants for esophagitis and its severity is crucial for appropriate management.
Purpose of the Study:
- To develop clinical and laboratory criteria for identifying young children with GER at high risk for esophagitis.
- To monitor the clinical course of these children.
- To evaluate the prognostic value of initial histologic findings in predicting treatment outcomes.
Main Methods:
- Prospective study of 40 infants (2-22 months) with persistent GER symptoms.
- Utilized 18-hour intraesophageal pH monitoring, endoscopy, and esophageal biopsies (grasp and suction).
- Assessed clinical parameters including weight gain, wheezing, irritability, and stool occult blood.
Main Results:
- Esophagitis prevalence was high across age groups: 80% under 7 months, 86% between 7-12 months, and 83% between 12-24 months.
- Esophagitis frequency was similar regardless of poor weight gain, wheezing, or irritability.
- Intraesophageal pH monitoring parameters lacked sensitivity and specificity for identifying esophagitis.
- Fundoplication was eventually required in 50% of patients with severe esophagitis, 14% with mild esophagitis, and 0% without esophagitis.
Conclusions:
- Current clinical and laboratory assessments for GER have limited utility in identifying children with esophagitis.
- Histologic evidence of severe esophagitis at initial evaluation may predict a higher likelihood of medical therapy failure and need for fundoplication.
- Further research is needed to refine diagnostic criteria and prognostic indicators for pediatric GER-associated esophagitis.
Abstract:
To develop clinical and laboratory criteria to identify young children with gastroesophageal reflux (GER) who are at particular risk for esophagitis and then to monitor their clinical course we have prospectively studied 40 subjects (ages 2-22 months, mean 8 months) with persistent symptoms of GER with 18 h intraesophageal pH monitoring, endoscopy, and grasp and suction esophageal biopsies. Esophagitis was found in 16 of 20 patients under 7 months, 12 of 14 between 7 and 12 months, and five of six between 12 and 24 months. Esophagitis was equally frequent in those patients with or without poor weight gain, wheezing, or irritability. Only 15% of patients with esophagitis had occult blood in their stool. No parameter of intraesophageal pH monitoring was both sensitive and specific in identifying patients who were ultimately found to have either mild or severe esophagitis. Follow-up data (37 patients) revealed that fundoplication was eventually required in four of eight patients with severe esophagitis, three of 22 with mild esophagitis, and none of seven without esophagitis. Currently used clinical and laboratory assessments of GER have limited value in identifying those children with either normal esophageal mucosa or at risk for varying degrees of esophagitis. Preliminary observations suggest that the presence of severe histologic esophagitis at the time of initial evaluation may have prognostic value in identifying those patients most likely to fail medical therapy and require fundoplication.