Diagnosis and treatment of reflux esophageal stricture in children

Abstract

Objective To explore the features of diagnosis and treatment of reflux esophageal stricture in children. Methods A retrospective review was performed for 11 children with reflux esophageal stricture from January 2013 to February 2017.There were 8 boys and 3 girls.There were sliding hiatal hernia plus reflux esophageal stricture (n=9) and reflux esophageal stricture (n=2). The clinical features, diagnosis, treatment and prognosis were summarized. Results All of them had recurrent vomiting and dysphagia.The diagnosis of reflux was confirmed by upper gastrointestinal (UGI) contrast (n=5), 24-hour esophageal pH monitoring (n=3), radioisotopic examination (n=1) and endoscopy (n=2); the diagnosis of stricture through endoscopy (n=5), UGI (n=4) and endoscopy plus UGI (n=2) respectively.All had lower oesophagitis.Four failed cases of esophageal dilation required anti-reflux surgery and the average session of dilation was 2.75.Four children underwent anti-reflux surgery with an average session of esophageal dilation at 2.25.Three cases underwent hiatal hernia repair (n=1) and resection of esophageal stricture (n=2) plus additional anti-reflux surgery.The average session of dilation was 7.For anti-reflux surgery, laparoscopic Nissen’s (n=4), Nissen’s open (n=5) or Thal’s open (n=2) were performed.Except for two cases who lost follow-ups, another 9 patients were tracked until April 25, 2018.All children ingested well and gained satisfactory weight after surgery. Conclusions Children with esophageal stricture due to gastroesophageal reflux respond well after esophageal dilation plus anti-reflux surgery.When oesophagitis affects muscular layer, resection of esophageal stricture and anti-reflux surgery are required.Gastroscope, esophageal pH monitoring and UGI are helpful in distinguishing between congenital esophageal stricture and peptic esophageal stricture. Key words: Gastroesophageal reflux; Esophageal Stenosis; Esophageal achalasia