Acute food bolus impaction without stricture in children with gastroesophageal reflux

Background/Purpose: This report identifies a group of children in whom seve re acute food bolus impaction (AFBI) was the leading symptom of gastroesoph ageal reflux (GER) in the absence of stricture. Methods: The esophageal structure and function of 8 patients treated for AF BI requiring endoscopic removal of alimentary foreign bodies in 6 of them ( up to 4 times in 1 case) were investigated by barium meal, esophagoscopy-bi opsy, pH-metering, pull-through stationary manometry, and 24-hour ambulator y manometry. The results were compared with those in a group of age-matched regular refluxers (n = 14) without AFBI. Results: Six boys and 2 girls aged 108 +/- 59 months had impaction. Six chi ldren had symptoms of GER like vomiting during infancy, heartburn, or respi ratory tract disease. Barium swallow ruled out stenosis in all patients and showed small hiatal hernias in 3. All had endoscopic and histologic esopha gitis (moderate to severe in 6), and one had Schatzki ring. All but one (wh o had 8.45 mm Hg) had normal lower esophageal sphincter pressure (16.2 +/- 4.7 mm Hg, mean +/- SID), and all showed normal sphincteric relaxation. Eso phageal body motility was not significantly different from that in regular refluxers except in 6 children in whom energetic distal peristalsis after r eflux episodes could be seen particularly during the night. Three of them h ad amazingly powerful distal waves during the day and even stronger, simult aneous, wide and bizarre-shaped waves during sleep. Symptoms improved in al l cases after antireflux medication. Four patients were cured after antiref lux surgery. Conclusions: AFBI is a dramatic but practically unheard of symptom of GER i n children. It should be differentiated from dysphagia and reveals motor dy sfunction, sometimes severe, of the esophageal body in the absence of sphin cteric obstruction. Antireflux medication or surgery were uniformly success ful in our patients. J Pediatr Surg 36:1397-1400, Copyright (C) 2001 by WB, Saunders Company.