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

Published:February 28, 2011DOI:https://doi.org/10.1016/j.gie.2011.01.017

      Background

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

      Objective

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

      Design

      A prospective, cross-sectional study.

      Setting

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

      Patients

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

      Intervention

      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.

      Results

      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.

      Limitations

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

      Conclusion

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

      Abbreviations:

      CI (confidence interval), BE (Barrett's esophagus), PPI (proton pump inhibitor), SD (standard deviation)
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