Original article Clinical endoscopy| Volume 73, ISSUE 5, P875-880, May 2011

Download started.


Barrett's esophagus in children and adolescents without neurodevelopmental or tracheoesophageal abnormalities: a prospective study

Published:February 28, 2011DOI:


      Barrett's esophagus (BE) in children has been examined in retrospective studies, consisting of case series and cross-sectional studies.


      To evaluate the prevalence and determinants of BE in children who are free from neurodevelopmental disorders and tracheoesophageal abnormalities.


      A prospective, cross-sectional study.


      Three pediatric GI Centers in Houston, Texas; Phoenix, Arizona; and Portland, Maine between February 2006 and December 2007.


      This study involved children and adolescents consecutively presenting for elective upper endoscopy. Patients with neurodevelopmental and tracheoesophageal disorders were excluded.


      Endoscopic pictures of all cases with suspected BE were independently reviewed and verified by two experienced investigators. Esophageal biopsy specimens were obtained in all patients, and targeted biopsy specimens also were obtained from suspected BE.

      Main Outcome Measurements

      Endoscopically suspected BE and histologically confirmed BE.


      A total of 840 patients (mean age 9.5 years) were enrolled and had complete questionnaire and endoscopic data. Twelve patients were suspected of having BE (prevalence of 1.43%; 95% confidence interval [CI], 0.73-2.45), and only 1 patient had intestinal metaplasia, for a prevalence of 0.12% (95% CI, 0-0.65), whereas the rest had gastric oxyntic glands (n = 6) or squamous esophageal epithelium (n = 5). Patients with suspected BE had a higher mean body mass index (23.0 vs 19.1, P = .05) and more chest pain (50% vs 13%, P < .01) than patients without BE or reflux esophagitis. There was a trend toward a higher frequency of dysphagia, heartburn, and regurgitation in patients with suspected BE.


      The accuracy of BE prevalence estimates is limited by the small number of cases.


      BE is rare in children without neurodevelopmental delay or tracheoesophageal anomalies presenting for elective upper endoscopy.


      CI (confidence interval), BE (Barrett's esophagus), PPI (proton pump inhibitor), SD (standard deviation)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Shepherd R.W.
        • Wren J.
        • Evans S.
        • et al.
        Gastroesophageal reflux in children: clinical profile, course and outcome with active therapy in 126 cases.
        Clin Pediatr (Phila). 1987; 26: 55-60
        • Campanozzi A.
        • Boccia G.
        • Pensabene L.
        • et al.
        Prevalence and natural history of gastroesophageal reflux: pediatric prospective survey.
        Pediatrics. 2009; 123: 779-783
        • El-Serag H.B.
        • Gilger M.
        • Carter J.
        • et al.
        Childhood GERD is a risk factor for GERD in adolescents and young adults.
        Am J Gastroenterol. 2004; 99: 806-812
        • El-Serag H.B.
        • Gilger M.
        • Kuebeler M.
        • et al.
        Extraesophageal associations of gastroesophageal reflux disease in children without neurologic defects.
        Gastroenterology. 2001; 121: 1294-1299
        • El-Serag H.B.
        • Bailey N.R.
        • Gilger M.
        • et al.
        Endoscopic manifestations of gastroesophageal reflux disease in patients between 18 months and 25 years without neurological deficits.
        Am J Gastroenterol. 2002; 97: 1635-1639
        • Orenstein S.R.
        • Shalaby T.M.
        • Kelsey S.F.
        • et al.
        Natural history of infant reflux esophagitis: symptoms and morphometric histology during one year without pharmacotherapy.
        Am J Gastroenterol. 2006; 101: 628-640
        • Nelson S.P.
        • Chen E.H.
        • Syniar G.M.
        • et al.
        Prevalence of symptoms of gastroesophageal reflux during childhood: a pediatric practice-based survey.
        Arch Pediatr Adolesc Med. 2000; 154: 150-154
        • Hassall E.
        Columnar-lined esophagus in children.
        Gastroenterol Clin North Am. 1997; 26: 533-548
        • El-Serag H.B.
        • Gilger M.A.
        • Shub M.D.
        • et al.
        The prevalence of suspected Barrett's esophagus in children and adolescents: a multicenter endoscopic study.
        Gastrointest Endosc. 2006; 64: 671-675
        • Gilger M.A.
        • El-Serag H.B.
        • Gold B.D.
        • et al.
        Prevalence of endoscopic findings of erosive esophagitis in children: a population-based study.
        J Pediatr Gastroenterol Nutr. 2008; 47: 141-146
        • Hassall E.
        Endoscopy in children with GERD: “the way we were” and the way we should be.
        Am J Gastroenterol. 2002; 97: 1583-1586
        • Armstrong D.
        Review article: towards consistency in the endoscopic diagnosis of Barrett's oesophagus and columnar metaplasia.
        Aliment Pharmacol Ther. 2004; 20: 40-47
        • Sharma P.
        • Dent J.
        • Armstrong D.
        • et al.
        The development and validation of an endoscopic grading system for Barrett's esophagus: the Prague C & M criteria.
        Gastroenterology. 2006; 131: 1392-1399
        • Lundell L.R.
        • Dent J.
        • Bennett J.R.
        • et al.
        Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification.
        Gut. 1999; 45: 172-180
        • Sherman P.M.
        • Hassall E.
        • Fagundes-Neto U.
        • et al.
        A global, evidence-based consensus on the definition of gastroesophageal reflux disease in the pediatric population.
        Am J Gastroenterol. 2009; 104: 1278-1295
        • Nandurkar S.
        • Talley N.J.
        Epidemiology and natural history of reflux disease.
        Baillieres Best Pract Res Clin Gastroenterol. 2000; 14: 743-757
        • Hassall E.
        Esophageal metaplasia: definition and prevalence in childhood.
        Gastrointest Endosc. 2006; 64: 676-677
        • Winters Jr., C.
        • Spurling T.J.
        • Chobanian S.J.
        • et al.
        Barrett's esophagus: a prevalent, occult complication of gastroesophageal reflux disease.
        Gastroenterology. 1987; 92: 118-124
        • Sarr M.G.
        • Hamilton S.R.
        • Marrone G.C.
        • et al.
        Barrett's esophagus: its prevalence and association with adenocarcinoma in patients with symptoms of gastroesophageal reflux.
        Am J Surg. 1985; 149: 187-193
        • Falk G.W.
        Barrett's esophagus.
        Gastroenterology. 2002; 122: 1569-1591
        • Lieberman D.A.
        • Oehlke M.
        • Helfand M.
        Risk factors for Barrett's esophagus in community-based practice.
        Am J Gastroenterol. 1997; 92: 1293-1297
        • Eisen G.M.
        • Sandler R.S.
        • Murray S.
        • et al.
        The relationship between gastroesophageal reflux disease and its complications with Barrett's esophagus.
        Am J Gastroenterol. 1997; 92: 27-31