Endoscopic manifestations of gastroesophageal reflux disease in patients between 18 months and 25 years without neurological deficits

Abstract

OBJECTIVE: The aim of this study was to determine the prevalence of erosive esophagitis and Barrett’s esophagus (BE) among a large cohort of neurologically normal children with gastroesophageal reflux disease (GERD). METHODS: We identified all patients between 18 months and 25 yr of age with GERD who underwent an upper endoscopy with biopsies during 1996–2000 at Texas Children’s Hospital. A manual review of the endoscopy and histopathology reports was performed. We excluded patients with mental retardation, cerebral palsy, congenital esophageal anomalies, or those with incomplete endoscopic description of the esophagus or absent histopathological reports on esophageal biopsies if BE was suspected. We analyzed the demographic, endoscopic, and histopathological findings and determined the prevalence of erosive esophagitis (defined by erosions/ulcers) and BE in children without neurological or congenital esophageal anomalies. RESULTS: We identified 402 neurologically normal children without congenital esophageal anomalies who had GERD. Of these, 208 (51.7%) patients were female. The mean age of the patients was 9.7 yr (range 1.5–25 yr). The ethnic distribution was as follows: 64.7% white, 7.7% black, 11.7% Hispanic, and 15.9% other. Erosive esophagitis was reported in 139 patients (34.6%). There were no statistically significant differences in the demographic characteristics of patients with and without erosive esophagitis. At endoscopy, BE was suspected in 11 patients (2.7%) because of the presence of pink colored mucosa at the lower end of the tubular esophagus. Histopathological examination of two to four targeted biopsies taken from these areas revealed fundic gastric glands with no evidence of intestinal metaplasia in any of these 11 patients. CONCLUSIONS: Manifestations of severe disease such as erosive esophagitis were present in more than one-third of patients in a large cohort of neurologically normal children with GERD who underwent endoscopy. Further studies are needed to examine the future subsequent clinical course of these children. On the other hand, BE was absent making it likely that the duration of reflux is a major risk factor for BE.