Abstract
BackgroundAcid suppression with a proton pump inhibitor is standard treatment for gastroesophageal reflux disease and erosive esophagitis in adults and increasingly is becoming first-line therapy for children aged 1-17 years. We evaluated endoscopic healing of erosive esophagitis with esomeprazole in young children with gastroesophageal reflux disease and described esophageal histology.MethodsChildren aged 1-11 years with endoscopically or histologically confirmed gastroesophageal reflux disease were randomized to esomeprazole 5 or 10 mg daily (< 20 kg) or 10 or 20 mg daily (≥ 20 kg) for 8 weeks. Patients with erosive esophagitis underwent an endoscopy after 8 weeks to assess healing of erosions.ResultsOf 109 patients, 49% had erosive esophagitis and 51% had histologic evidence of reflux esophagitis without erosive esophagitis. Of the 45 patients who had erosive esophagitis and underwent follow-up endoscopy, 89% experienced erosion resolution. Dilation of intercellular space was reported in 24% of patients with histologic examination.ConclusionsEsomeprazole (0.2-1.0 mg/kg) effectively heals macroscopic and microscopic erosive esophagitis in this pediatric population with gastroesophageal reflux disease. Dilation of intercellular space may be an important histologic marker of erosive esophagitis in children.Trial RegistrationD9614C00097; ClinicalTrials.gov identifier NCT00228527.
Highlights
Acid suppression with a proton pump inhibitor is standard treatment for gastroesophageal reflux disease and erosive esophagitis in adults and increasingly is becoming first-line therapy for children aged 1-17 years
Endoscopy is a valuable tool in the diagnosis of pediatric Gastroesophageal reflux disease (GERD) and erosive esophagitis (EE) that provides macroscopic evidence of erosions, histology is important because abnormalities may be present without visible lesions on endoscopy
Esophagitis is diagnosed by the presence of epithelial hyperplasia, intraepithelial inflammation, vascular dilatation in papillae, balloon cells, and ulceration [5]
Summary
Acid suppression with a proton pump inhibitor is standard treatment for gastroesophageal reflux disease and erosive esophagitis in adults and increasingly is becoming first-line therapy for children aged 1-17 years. We evaluated endoscopic healing of erosive esophagitis with esomeprazole in young children with gastroesophageal reflux disease and described esophageal histology. Gastroesophageal reflux disease (GERD) increasingly is recognized in young children. The prevalence of endoscopy- and biopsy-proven EE in one study was 29% in 209 patients with GERD aged 18 months to 10 years who had no neurologic abnormalities or congenital esophageal anomalies [2]. Mucosal biopsies are recommended but not mandatory in current pediatric endoscopy practice to exclude potentially confounding diagnoses, such as eosinophilic or infectious esophagitis and, less commonly, Barrett's esophagus [4]
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