BARRETT'S EPITHELIUM RESULTING FROM CHRONIC GASTROESOPHAGEAL REFLUX (GER) IN CHILDREN

Abstract

Histologic changes seen on esophageal biopsies in children with GER may include normal squamous epithelium, changes in rete peg height & inflammatory infiltrates of PMN's or eosinophils. While severe GER in adults may be accompanied by replacement of normal esophageal epithelium with columnar epithelium (Barrett's epithelium), this complication is not appreciated in children.

4 children (ages 2-10 yrs) with severe GER complicating mental deficiency syndromes or multiple congenital abnormalities (VATER syndrome) were found to have Barrett's esophagus. Severe GER was documented in each : UGI (+4/4), Tc99m milk scan (+4/4), 24 hr. esophageal pH monitoring (+4/4). The endoscopic appearance of the mucosa was consistent with moderate esophagitis in 3/4, mild esophagitis in 1. Biopsies were obtained at least 3 cm proximal to the GE junction or at an area of demarcation between normal and abnormal mucosa. All patients had evidence of gastric columnar epithelium upon histological examination of the tissue; 3/4 showed fundal mucosa with chief cells, 1 showed junctional type mucosa. In addition, all patients had infiltrates of chronic inflammatory cells in the lamina propria. 3/4 patients underwent elective fundoplication.

Conclusion: Barrett's epithelium may be seen as a complication of GER in children. Because the natural history of Barrett's following correction of GER is unknown in children, careful survalence is indicated due to the premalignant potential of these changes.

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