Clinical and endoscopic predictors of histological oesophagitis in infants

Abstract

Objective: To define the earliest age at which histological changes can be used to diagnose oesophagitis and to determine the relationships between clinical, endoscopic and histological features of oesophagitis in infants. Methodology: The case records and biopsies of 113 infants aged 2-18 months with clinically significant gastro-oesophageal reflux (GOR), undergoing oesophagoscopy between 1978 and 1994 were retrospectively reviewed. The biopsies were independently evaluated and graded by two pathologists. Results: Forty-five cases (40%) had histological oesophagitis but only 16 (1 4%) had abnormal endoscopic findings (excluding erythema). Endoscopy was found to be highly specific (93%) for histological oesophagitis but lacked sensitivity (25%). Irritability was inversely related to the presence of endoscopic abnormalities, and there was poor correlation between symptoms and histological changes with only haematemesis showing a statistically significant association with histological abnormalities (P = 0.033). Intraepithelial lymphocytes were the earliest of the histological features noted and were present before 4 months of age. The numbers of intraepithelial eosinophils and lymphocytes and the presence of papillary elongation all increased with age. Conclusions:The presence of oesophagitis is difficult to predict on the basis of symptoms. The presence of intraepithelial lymphocytes is the earliest histological change to be seen in infants with GOR, and can develop before 4 months of age. Oesophagoscopy without biopsy is unreliable in the diagnosis of oesophagitis in infants.

A neurobiological model for cry-fuss problems in the first three to four months of life

“…This has resulted in widespread inappropriate diagnosis and treatment of gastro-oesphageal reflux disease (GORD), lactose intolerance, and food allergy in crying babies in the first three to four months of life [16,51,52]. Despite the ongoing popularity of these diagnoses, anti-secretory medications have been shown to be no more effective than placebo [53,54], and the mucosal inflammation of acid-peptic or allergic oesophagitis is very rarely demonstrated in crying babies in the first three or four months [55,56]. Complicated maternal elimination diets are popular amongst breastfeeding mothers.…”

Gastroesophageal Reflux in Young Children and Adolescents

“…Three old pediatric studies on persisting GERD symptoms showed no relation between the extent of symptoms and esophagitis. Finally, in 1997 Chadwick et al (20) studied an infant population, reporting a significant correlation between the histological lesions of the esophagus and hematemesis episodes. A few years later Treem et al (5) confirmed these findings in a population of older children and adolescents.…”

Are Symptoms of Gastroesophageal Reflux in Children Associated with Diagnoses of Endoscopic and/or Histological Esophagitis?

“…retrospektif çalışmalarında, yaşları 2-18 ay arasında değişen toplam 113 süt ço-cuğundan 63 (%56)'ünde endoskopik özofajit saptanmayarak normal bulunduğunu bildirmişlerdir. 24 Vieira ve ark.nın 167 süt çocuğunu kapsayan retrospektif çalışmasında da, hastaların 96 (%57,5)'sında endoskopik özofajit saptanmayıp normal olarak değerlendirilmiştir. 25 özofajit saptanmayarak normal bulunmuştur.…”

“…ile Vieira ve ark.nın normal olarak bildirdikleri oranlara göre (sırasıyla %56 ve %57,5) daha yük-sektir. 24,25 Çalışmamızın diğer iki çalışmadan farklı olarak Los Angeles değerlendirme sisteminde özo-fajit tanısı için esas alınan temel makroskopik bulgunun mukozal erozyon olup, hiperemi veya kolay hasarlanabilme gibi diğer endoskopik makroskopik değişikliklerin ise endoskopik özofajit tanısında dikkate alınmamasının endoskopide normal bulunma oranında artışa yol açtığı ileri sürülebilir.…”