Malignant Risks of Barrett’s Esophagus in Children

Abstract

Surgery| April 01 1999 Malignant Risks of Barrett’s Esophagus in Children AAP Grand Rounds (1999) 1 (4): 33–34. https://doi.org/10.1542/gr.1-4-33 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Malignant Risks of Barrett’s Esophagus in Children. AAP Grand Rounds April 1999; 1 (4): 33–34. https://doi.org/10.1542/gr.1-4-33 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: barrett's esophagus Source: Beddow ECL, Wilcox D, Drake DP, Pierro A, Kiely EM, Spitz L. Surveillance of Barrett’s esophagus in children. J Ped Surg. 1999;34:88–91. Repeated episodes of gastroesophageal (GE) reflux are thought to play a major role in the development of Barrett’s esophagus in children – the replacement of normal squamous esophageal epithelium by a columnar intestinal epithelial lining. Prior reports have documented that this is a pre-malignant condition that increases the risk of carcinoma of the esophagus 30-fold in untreated adults. While GE reflux is common in children, the role of endoscopic surveillance in children with Barrett’s esophagus is unknown, as is the potential for histologic improvement following either medical treatment or surgical fundoplication to prevent further mucosal injury from acid reflux events. The authors reviewed records of 38 children with documented Barrett’s esophagus treated at London’s Great Ormond Street Hospital from 1982 to 1997, followed up for an average of 43 months. Mean age at diagnosis was 6.3 years, range 1–15 years. Two were treated medically. Thirty-six underwent fundoplication. Thirty had a Nissen procedure, 2 with adjuvant medical therapy, 1 with esophageal dilation; 4 had a 270°Thal procedure, 1 with esophageal dilation. Twenty-seven children had annual esophageal endoscopy and biopsy that showed persistent Barrett’s esophagus in 15, mild esophagitis in 2, and conversion to normal esophageal mucosa in 10. There was no evidence of dysplastic or malignant change in any patient. All cases that reverted to normal esophagus or had only mild esophagitis had previously undergone surgical fundoplication. The authors recommend combined medical and surgical reflux treatment with follow-up esophageal biopsy every 3 to 4 years for children with Barrett’s esophagus. Barrett’s esophagus in childhood is very uncommon and most likely arises from the effects of chronic gastroesophageal reflux disease (GERD). However, some patients with Barrett’s esophagus may not have GERD even though they have reflux symptoms; autopsy studies indicate the columnar esophageal epithelium may be present at birth. Patients without reflux may thus have no prospect for resolution of their Barrett’s esophagus with an antireflux operation. Barrett’s esophagus is a histologic diagnosis which traditionally has included patients with specialized columnar epithelium (intestinal-type epithelium) in the esophagus but may also include other types of columnar epithelium. Since specialized columnar epithelium is associated with the risk of developing adenocarcinoma of the esophagus, some investigators have suggested that only patients with this type of columnar epithelium in the esophagus be called Barrett’s esophagus and chosen for surveillance. However, this may result in patients with other types of columnar epithelium being ignored and lost to follow-up even though their metaplastic epithelium may progress to the specialized columnar type. With most cases of Barrett’s esophagus and adenocarcinoma appearing in adults 50 to 60 years old, the follow-up of children with Barrett’s esophagus is critically important to determine the origins of Barrett’s esophagus and to protect the patient from the development of esophageal adenocarcinoma. This paper is important for the clinician to understand since the definitive control of GERD... You do not currently have access to this content.