Peptic oesophageal stricture in children: Management problems

Zouari, Mohamed; Kamoun, Houda; Bouthour, H.; Abdallah, R. Ben; Hlel, Youssef; Malek, Riath Ben; Gharbi, Y.; Kaabar, N

doi:10.4103/0189-6725.129206

Cited by 8 publications

(14 citation statements)

References 33 publications

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“…Most of these strictures are found in the distal-third of the oesophagus. [19] In this study, 5% of OSs were secondary to gastrooesophageal reflux disease. Generally, this type of OS responds well to dilatation, and complete resolution occurs in 70 -90% of cases when dilation is combined with treatment with proton pump inhibitors.…”

Section: Discussionmentioning

confidence: 56%

“…Generally, this type of OS responds well to dilatation, and complete resolution occurs in 70 -90% of cases when dilation is combined with treatment with proton pump inhibitors. [19,20] Children account for about 80% of cases of FB ingestion. The most frequently ingested FBs are coins, bones, and button batteries, which can damage the oesophagus and lead to strictures.…”

Section: Discussionmentioning

confidence: 99%

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An audit of the management of oesophageal stricture in children in Durban, KwaZulu-Natal Province, South Africa

Moumin

Hadley

2017

S Afr J CH

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Oesophageal strictures (OSs) are common in resource-poor countries. In children, OSs may result from surgery to the oesophagus, such as repair of oesophageal atresia, or following repeated sclerotherapy for oesophageal varices; however, OSs are most commonly caused by chemical injuries. [1] OSs are occasionally seen in children with untreated gastro-oesophageal reflux, most notably in those with neurological impairment, and also after oesophageal infections, especially in HIV-positive children. [1-3] The goals of management are to relieve dysphagia, ensure adequate nutrition for growth and development, and to prevent aspiration pneumonia and recurrence of the stricture by oesophageal dilatation, stenting, or replacement surgery. [4,5] There are several parameters that have been used to define the outcome of patients suffering from OSs, of which the clinical resolution of dysphagia is considered the most relevant. Many patients report significantly improved symptoms shortly after dilatation, but these gradually worsen over time. [1,4,6] The aim of this study was to describe the aetiology and outcomes of the management of OSs in children in Durban, KwaZulu-Natal Province (KZN), South Africa (SA). Methods The study design was approved by the Biomedical Research Ethics Committee of the University of KwaZulu-Natal (ref. no. BE044/14), the Department of Health and the management of Inkosi Albert Luthuli Central Hospital. A retrospective chart review was conducted of all paediatric patients aged <14 years, who had been admitted for management of OSs at Inkosi Albert Luthuli Central Hospital in Durban, KZN, SA from July 2002 to December 2010. Management status at 3 years after presentation was used to define outcome. Data collected from the patients' files were manually entered into a Microsoft Excel spreadsheet. Patient demographics included age, gender, race, comorbidities, aetiological factors, diagnostic investigations, type of endoscope used, location and number of strictures, duration of treatment, complications, recurrence, adjuvant therapy, and patient outcomes. Diagnosis of OS was made endoscopically and radiologically. Operative procedures were performed under general anaesthesia by different paediatric surgeons and trainees. Results Thirty-nine patients were identified and included in our review. Their ages ranged from 1 month to 13 years, and there were 18 (46%) males and 21 (54%) females. Most participants were black South Africans (36 (92%)), in keeping with the demographics of the population served. Eleven children (28%) were HIV-infected, (5%) were HIVexposed, and 23 (59%) children had not been tested for HIV. Strictures secondary to surgical correction of oesophageal atresia (14 (35.9%)) were the most common, followed by OSs due to corrosive injury (12 (30.8%)). HIV-related strictures were seen in 8 (21%) children, while gastro-oesophageal reflux (2 (5%)), and foreign body (FB) ingestion (3 (7.6%)) were less common. The most common stricture site was the middle-third of the oesophagus (51%), with 33.3% i...

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

An audit of the management of oesophageal stricture in children in Durban, KwaZulu-Natal Province, South Africa

Moumin

Hadley

2017

S Afr J CH

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“…Paraclinical studies are very useful for diagnosis; esophagram series allow for discrimination among reflux-related lesions, embryonic remnants, or achalasia, but undoubtedly, endoscopy carries the most weight in establishing a final diagnosis in this kind of patients. Stenosis due to reflux could occur anywhere in the esophagus, but incidence is most common in the lower third, 5,6 its effect could reach the esophageal junction, with inflammatory data in the lower third with a friable mucosa, 9 as found in patients surveyed in this work. Endoscopies performed in patients with achalasia revealed no anatomical obstruction as the endoscope could go through toward the stomach, 11 with normal esophageal mucosa and a lack of cardia opening with air insufflation.…”

Section: Obstruction Of the Lower Third Of The Esophagus 203mentioning

confidence: 52%

“…Lower third esophageal obstruction can stem from a variety of rare pathologies. 3,5,10,11,13,14 Even when the esophagus might have several congenital lesions, this 33-case survey showed these could arise from gastroesophageal reflux, achalasia, or cartilaginous embryonic remnants. Even…”

Section: Discussionmentioning

confidence: 77%

“…T he nature of diseases that can potentially harm the whole esophagus or specific portions of it is varied. 1 For instance, causes rendering disruptions to regular food intake through the lower third of the esophagus could be intramural, of congenital origin, as is the case with embryonic remnants [2][3][4] ; acquired, via gastroesophageal reflux [5][6][7] ; or even due to changes in esophageal motility, as seen in achalasia patients. 8 Nevertheless, each of these conditions is quite rare.…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic Approach of the Obstruction of the Lower Third of the Esophagus in Children

García-Hernández

Carvajal-Figueroa

Archivaldo-García

et al. 2020

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Objective: To review the diagnostic methodology in pediatric patients with obstruction of the lower third of the esophagus as well as minimally invasive therapeutic options. Materials and Methods: Retrospective study carried out reviewing records of children with esophageal obstruction diagnostic, from 2000 to 2018. They were divided into Group I stenosis secondary to reflux; Group II achalasia; and Group III embryonic remnants. Results: Thirty-three patients. Group I: 7; esophageal barium swallow irregular stenosis of the distal third and endoscopy irregular stenosis in 7. Treated with laparoscopic fundoplication 2, Collis Nissen 5. Group II: 22 patients, age X = 11.55 years. All with dysphagia and symmetrical stenosis of esophagogastric junction. Fifteen underwent manometry and all underwent intraoperative endoscopy. All had laparoscopic myotomy, with 2 perforations and no conversions, 2 patients had subsequent dysphagia to solids, and they did not need esophageal dilatation. Group III: 4 patients, stenosis was above esophagogastric junction. On endoscopy, inflammation was present in all 3 with irregular esophagogastric junction and difficulty passing endoscope. Three patients underwent laparoscopic resection and anastomosis. One patient leaked and developed a fistula. One patient has not been operated upon as yet. Conclusions: In those patients, the best surgical option depends upon the diagnosis. Esophageal barium studies and endoscopy allow discerning among them.

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Chinese consensus on multidisciplinary diagnosis and treatment of gastroesophageal reflux disease 2022

Wu¹,

Wang²,

Bai³

et al. 2023

Gastroenterology & Endoscopy

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Peptic oesophageal stricture in children: Management problems

Abstract: GERD complicated by PES is an important condition affecting a significant number of children. Early and effective treatment of both stricture and GERD is required to improve the prognosis of this serious condition.

Cited by 8 publications

References 33 publications

An audit of the management of oesophageal stricture in children in Durban, KwaZulu-Natal Province, South Africa

An audit of the management of oesophageal stricture in children in Durban, KwaZulu-Natal Province, South Africa

Laparoscopic Approach of the Obstruction of the Lower Third of the Esophagus in Children

Chinese consensus on multidisciplinary diagnosis and treatment of gastroesophageal reflux disease 2022

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