Reflux oesophagitis in children; the role of endoscopy

Lombardi, G.; Angelis, G.L. De; Rutigliano, Vincenzo; Guariso, Graziella; Romano, Claudio; Falchetti, Diego; Pittschieler, K; Brunero, Marco; Lerro, P.; Sabbi, T.; Pepe, Gilda; Venuto, D. De; Torroni, Filippo; Bizzarri, Barbara; Nicola, Marta Di; Mascio, Rocco Di; Dall’Oglio, Luigi

doi:10.1016/j.dld.2007.05.018

Cited by 13 publications

(8 citation statements)

References 30 publications

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“…The most reliable endoscopic feature of GERD in adults, visible breaks in the esophageal mucosa [23], has been employed to develop an endoscopic scoring system that has been recommended for use in children [9,10]. Although expert consensus panels maintained that esophageal histopathology is unable to diagnose or to exclude pediatric GERD [9,10], a recent multicenter Italian study on GERD in children concluded that the histopathologic finding of esophageal inflammation is often a more sensitive criterion than endoscopic appearance [24]. These authors also found that both the endoscopic and the histologic scores of esophagitis improved after acid suppression therapy.…”

Section: Discussionmentioning

confidence: 99%

Lack of correlation between obesity and gastroesophageal reflux disease (GERD) in a pediatric cohort

Rabinowitz¹,

Goli²,

Xu³

et al. 2013

OJPed

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Objectives: Previous reports correlating obesity with gastroesophageal reflux disease (GERD) in children have yielded conflicting results. This study examined whether increasing BMI (body mass index) correlated with increasing grades of endoscopic and/or histopathologic GERD in a cohort of inner city children. Designs and Methods: 340 consecutive children (1-18 years) were classified as obese (BMI > 95%) for age and gender. Both endoscopic findings and esophageal histopathology were characterized by graded adult GERD scoring systems. Normal and abnormal grades were then stratified based on BMI. Results: In the study cohort (mean age 10.5 ± 4.7 yrs), 29% were obese (BMI > 95%) and 24% of the total cohort demonstrated endoscopic features of GERD. With increasing severity of endoscopic GERD (from normal to advanced), the percentage of obese patients at each grade did not increase (Grade 0 = 30%, Grade 1 = 26%, Grades 2-4 = 30%). Histopathologic findings consistent with GERD were noted in 21% of the total population studied. Again, the percentage of obese children in each diagnostic category (Grades 0-3) did not increase with increasing severity of inflammation. Conclusions: In this cohort of inner city children, obesity was not associated with an increased prevalence of GERD as defined by adult scoring systems.

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Section: Discussionmentioning

confidence: 99%

Lack of correlation between obesity and gastroesophageal reflux disease (GERD) in a pediatric cohort

Rabinowitz¹,

Goli²,

Xu³

et al. 2013

OJPed

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“…7 In an Italian study, endoscopy often underestimated the severity of histologic findings. 8 Oderda et al 9 found a concordance of only 13.8% when comparing 32 biopsies with duodenal damage with their endoscopic findings. Other studies have begun to compare specific endoscopic findings with histologic findings, which also have poor concordance.…”

Section: Introductionmentioning

confidence: 96%

The concordance of endoscopic and histologic findings of 1000 pediatric EGDs

Sheiko

Feinstein

Capocelli

et al. 2015

Gastrointestinal Endoscopy

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Background Pediatric gastroenterologists frequently perform routine endoscopic biopsies despite normal-appearing mucosa during EGD. Older small studies have supported this practice. Objective To re-evaluate the concordance between endoscopic appearance and histology in the era of high-definition endoscopy. Design Retrospective cohort study. Setting Single tertiary care center. Patients A total of 1000 pediatric patients undergoing initial EGD. Main Outcome Measurements Endoscopic and histologic findings. Results The overall rate of an endoscopic finding was 34.7%, which was 40.4% of a histologic finding. Concordance between the presence of any endoscopic finding and any histologic finding in all locations was 69.9% (Cohen's κ coefficient = 0.32). In the esophagus, the concordance between any endoscopic finding and any histologic finding was 82.6% (κ = 0.45). The stomach was 73.2% concordant (κ = 0.18), and the duodenum was 89.3% concordant (κ = 0.42). The κ coefficient decreased when comparing specific findings in each location; it was 0.34 in the esophagus, 0.17 in the stomach, and 0.34 in the duodenum. If biopsy specimens had only been obtained when the endoscopist identified abnormal mucosa, 48.5% of the pathologic findings would have been missed. In patients with histology consistent with eosinophilic esophagitis, 30.2% had normal-appearing mucosa. For celiac disease, 43% had normal-appearing mucosa. In the stomach, an abnormal endoscopic appearance was more likely to have normal histology. Limitations The single-center, retrospective nature and more endoscopists than pathologists. Conclusions These data support the routine collection of biopsy specimens in the duodenum, stomach, and esophagus during EGD in pediatric patients.

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“…A study published by Zentilin et al in 2005 showed that histology could provide useful and objective additional data in patients with nonerosive reflux disease [18]. Furthermore, Lombardi et al suggested that esophageal biopsies are very important aids in the diagnosis of esophagitis since clinical symptoms of GERD or endoscopic visual findings do not always correlate with histologic abnormalities [19]. …”

Section: Introductionmentioning

confidence: 99%

The Association between Childhood Overweight and Reflux Esophagitis

et al. 2010

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Background. In adults, it has been shown that obesity is associated with gastroesophageal reflux disease (GERD) and GERD-related complications. There are sparse pediatric data demonstrating associations between childhood overweight and GERD. Objective. To investigate the association between childhood overweight and RE. Methods. We performed a retrospective chart review of 230 children (M : F = 114 : 116) who underwent esophagogastroduodenoscopy (EGD) with biopsies between January 2000 and April 2006. Patient demographics, weight, height, clinical indications for the procedure, the prevalence of BMI classification groups, the prevalence of RE and usage of anti-reflux medications were reviewed. For these analyses, the overweight group was defined to include subjects with BMI≥ 85th percentile. The normal weight group was defined to include subjects with BMI 5th to 85th percentile. Results. Among the 230 subjects, 67 (29.1%) had BMI percentiles above the 85th percentile for age and gender. The prevalence of RE in the overweight group did not differ significantly from that in the normal weight group (23.9% versus 24.5%, resp.). Overweight subjects taking anti-reflux medications clearly demonstrated a higher prevalence of biopsy-proven RE compared to overweight subjects not taking anti-reflux medications (34.1% versus 7.7%, P = .009). Conclusions. There was no significant difference in the prevalence of biopsy-proven RE in the overweight group compared to the normal weight group. However, the prevalence of RE was significantly higher in overweight subjects on anti-reflux medications compared to overweight subjects not taking anti-reflux medications. This finding emphasizes the importance of early recognition and treatment of GERD for the overweight pediatric patients with symptoms in conjunction with weight loss program for this population to reduce long-term morbidities associated with GERD.

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Reflux oesophagitis in children; the role of endoscopy

Cited by 13 publications

References 30 publications

Lack of correlation between obesity and gastroesophageal reflux disease (GERD) in a pediatric cohort

Lack of correlation between obesity and gastroesophageal reflux disease (GERD) in a pediatric cohort

The concordance of endoscopic and histologic findings of 1000 pediatric EGDs

The Association between Childhood Overweight and Reflux Esophagitis

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