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High incidence of pulmonary symptoms in infants evaluated for esophageal disease
Insights
Pediatric pulmonary symptoms like apnea and pneumonia can signal esophageal dysfunction. Prompt, rigorous testing and appropriate interventions, such as Nissen fundoplication, can effectively manage severe cases in infants.
Area of Science:
- Pediatric Gastroenterology
- Pulmonology
- Gastrointestinal Disorders
Background:
- Infants and children presenting with pulmonary symptoms often have underlying esophageal dysfunction.
- Pulmonary manifestations such as apnea, pneumonia, and stridor can be indicative of gastroesophageal reflux disease (GERD) and other esophageal pathologies.
Purpose of the Study:
- To evaluate the diagnostic utility of various tests for esophageal disease in children with pulmonary symptoms.
- To assess the correlation between diagnostic findings and clinical presentation.
- To determine the efficacy of surgical intervention for refractory cases.
Main Methods:
- Retrospective review of 62 children (1-24 months) evaluated for esophageal disease.
- Diagnostic methods included upper gastrointestinal series, acid-reflux testing, endoscopy with biopsy, and fluorescopy.
- Surgical intervention (Nissen fundoplication) was performed in select cases.
Main Results:
- Twenty-two of 62 children had pulmonary symptoms; 10 showed gastroesophageal reflux, and 3 had strictures on upper GI series.
- Acid-reflux testing was positive in 13/15, correlating with esophagitis in 12.
- Endoscopy revealed esophagitis, foreign bodies, and strictures; suction biopsy proved more reliable than grasp biopsy for diagnosing esophagitis.
Conclusions:
- Esophageal dysfunction should be considered in children with prolonged, severe pulmonary symptoms.
- A combination of rigorous diagnostic testing is crucial for accurate diagnosis.
- Nissen fundoplication effectively resolved symptoms in infants with life-threatening esophageal disease unresponsive to medical therapy.
Abstract:
Of 62 children (1-24 months of age) evaluated for esophageal disease, 22 were found to have pulmonary symptoms of apnea, pneumonia, wheezing, cyanosis, cough and stridor. Upper gastrointestinal series showed free gastroesophageal reflux in 10 of 22 infants; 3 were thought to have stricture. Acid-reflux test was positive in 13 of 15 and correlated with the presence of esophagitis in 12. In addition to esophagitis, endoscopic examination found two foreign bodies and an esophageal stricture unrecognized during fluorescopy. Endoscopic grasp biopsy was inadequate in most infants for the histologic evaluation of esophagitis. However, suction biopsy correlated well with endoscopically diagnosed esophagitis. In infants where medical therapy failed and symptoms were life-threatening, a Nissen fundoplication resulted in excellent resolution of symptoms. In children who present with prolonged and often life-threatening symptoms, esophageal dysfunction should be evaluated by rigorous testing.