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When does reflux oesophagitis occur with gastro‐oesphageal reflux in infants? A clinical and endoscopic study, and correlation with outcome
Author(s) -
RYAN PATRICK,
LANDER MERVYN,
ONG T. H.,
SHEPHERD ROSS
Publication year - 1983
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/j.1440-1754.1983.tb02064.x
Subject(s) - medicine , irritability , reflux , endoscopy , failure to thrive , peptic , perforation , esophagitis , gastroenterology , gastro , surgery , disease , peptic ulcer , materials science , menopause , punching , metallurgy
. To evaluate the clinical and endoscopic features of peptic oesophagitis associated with gastro‐oesophageal reflux (GOR) in infants and children, and to correlate these features with outcome of GOR, we selected 62 patients with GOR aged 21 days to 10 years (median 6.5 months) with symptoms suggesting oesophagitis from a group of 126 patients with GOR for fiberoptic endoscopy. Clinical presentation, clinical features, investigations and management and outcome were recorded by computer‐aided analysis. Of the 62 patients studied, 34 (55%) had oesophagitis. Of these, nine had macroscopic ulceration and desquamation, 23 had macroscopic erythema and friability and two had strictures. Comparing those with and without oesophagitis, common clinical symptoms associated with oesophagitis included excessive crying, irritability and/or sleep disturbance often presenting as “colic” (85%), failure to thrive (41%), haematemesis (29%), and abnormal head and back posturing (7%). Maternal distress was common with GOR and oesophagitis in infants and three cases presented with child abuse. Four cases had associated neurological deficit. Of the 28 cases with minimal or no oesophagitis at endoscopy, 26 (93%) responded satisfactorily to conservative management whereas only 14 of 34 (41%) of the group with oesophagitis responded to conservative management including the use of cimetidine. The remainder of this group required antireflux surgery. We conclude that peptic oesophagitis is an often unrecognised important complication of GOR in infants and children which, apart from causing considerable morbidity may adversely affect prognosis. We emphasize the importance of diagnostic endoscopy in selected cases to detect pathological GOR, particularly where irritability, “colic”, sleep disturbance and haematemesis accompanies GOR as other diagnostic tests detect only the presence or absence of GOR, and are poor predictors of oesophagitis. Management of GOR in infants should include measures to prevent this important complication, and careful follow‐up of established cases seems prudent.