Endoscopic and Histological Features of Esophagitis in Children With Duodenogastric Reflux

Duodenogastric reflux (DGR), the backward flow of duodenal contents into the stomach, is often overlooked in children. This study aimed to evaluate the endoscopic and histopathological changes in the esophagus associated with DGR in children.

This retrospective study included 537 children aged 0-18 years who underwent esophagogastroduodenoscopy (EGD). DGR was defined by the presence of bile in the stomach upon initial endoscope entry together with concurrent endoscopic or histopathological evidence of gastritis. Conditions that could potentially confound the findings were excluded using defined exclusion criteria. Endoscopic and histopathological findings of the esophagus, stomach, and duodenum were evaluated for each patient.

DGR was detected in 22% of the patients. Endoscopic findings such as esophageal hyperemia, erosion, and ulceration were significantly more frequent in the DGR group (p < 0.001). Histopathologically, the frequency and severity of esophagitis were also higher in patients with DGR (p = 0.002 and p = 0.019, respectively). DGR was independently associated with higher odds of both endoscopic (Odds ratio (OR): 2.18, p = 0.004) and histopathological esophagitis (OR: 1.80, p = 0.008). Endoscopic signs of gastric mucosal injury, including erythema, friability, edema, and ulcers, were more common in the DGR group (p < 0.001); however, these findings were interpreted descriptively because gastritis was part of the DGR definition, and no significant difference was observed in gastric histopathology.

In pediatric patients, DGR is associated with significant esophageal mucosal injury at both endoscopic and histopathological levels. These findings indicate an increased risk of esophagitis in children with DGR and support the clinical value of esophageal biopsy during pediatric EGD.