BARRETTS-ESOPHAGUS IN CHILDREN - DIAGNOSIS AND MANAGEMENT

To determine the local prevalence and optimal therapy for children wit h Barrett's esophagus (BE), the authors studied children with esophage al strictures or gastroesophageal reflux (GER), or both, to diagnose B E and to follow after therapy. Summary Background Data Barrett's esoph agus is seldom reported in children and therapeutic recommendations ar e unclear. Barrett's esophagus usually develops during the mucosal rep arative process after acid-reflux injury to the esophageal mucosa. Ris k factors for BE include conditions that are associated with GER such as mental retardation, esophageal stricture, esophageal atresia, and r eversed gastric tube esophagoplasty. Barrett's syndrome increases the risk of esophageal adenocarcinoma by 30 to 40 times.8,9 Methods All ch ildren with the risk factors had repeated esophagoscopy and multiple m ucosal biopsies before and after therapy. Results Eleven children have been documented with BE. The initial diagnoses were: GER, 5; esophage al atresia, 4; nasogastric intubation, 1; lye ingestion, 1. A gastric tube esophagoplasty had been performed in three patients with BE in th e esophagus proximal to the anastomosis. Three children with mid-esoph ageal strictures and long segments of BE had total resection with coli c interposition. An additional two patients with tight stricture were treated with colic-patch esophagoplasty without resection. The final t hree patients were treated with fundoplication alone. Conclusions Barr ett's esophagus can be caused by acid from gastric tubes but responds to H-2 blockers and diet. Resection eliminates BE; esophagoplasty only controls the stricture and must be accompanied by fundoplication. Bar rett's esophagus persists in patients with fundoplication alone if ref lux control is incomplete. The authors conclude that acid reflux must be controlled to treat BE successfully or the involved segment must be resected. Esophagogastrostomy apparently predisposes to BE.21