REFLUX-ESOPHAGITIS IN YOUNG-CHILDREN - A RETROSPECTIVE STUDY OF 448 GASTROINTESTINAL ENDOSCOPIES

In young children, suspected esophagitis is among the most common reas ons for performing upper gastrointestinal endoscopy (UGIE). A retrospe ctive analysis of 448 (264 males and 184 females) UGIEs done in patien ts younger than three year-a of age to look for reflux esophagitis was performed. Group A was composed of the 331 patients known to have gas troesophageal reflux (GER) at the time of the UGIE and Group B of the remaining 117 patients. Results: In group A, only 44 patients (12 %) h ad evidence of esophagitis, which was grade 1 in 42 cases and grade 2 or higher in only two cases. Both patients with grade 2 esophagitis we re neonates (age less than or equal to 1 month) who were being evaluat ed because of an apparently life-threatening event. Neonates were more likely to have reflux esophagitis (22 %) than older patients. The pro portion of patients with grade 1 esophagitis vaned across operators fr om 2 % to 39 %, demonstrating that this diagnosis is highly subjective . Of the group B patients, 36 had evidence of esophagitis, which was g rade 1 in 30 cases and grade 2 or higher in six cases, Again, all the patients with esophagitis grade 2 or higher were neonates; the initial manifestation was an apparently life-threatening event in four cases and hematemesis in two. Sixty-nine per cent of the patients with esoph agitis were neonates. In this group also, the frequency of grade 1 eso phagitis varied markedly across operators, from 11 % to 46 %. Conclusi on: 1) reflux esophagitis is more common in neonates than in older chi ldren; 2) esophagitis grade 2 or higher is exceedingly rare in patient s with GER who are older than one month and younger than three years o f age; 3) the diagnosis of grade 1 esophagitis is heavily operator-dep endent and should be interpreted with caution; 4) apparently life-thre atening events and hematemesis are the symptoms most suggestive of ref lux esophagitis in infants.