The Inflammatory Polyp–Fold Complex in Children

Abstract

The inflammatory polyp-fold complex (IPFC) is an uncommon endoscopic or radiologic finding in children. In this complex, an inflammatory polyp at the gastroesophageal junction is present, often in continuity with a prominent gastric fold. Histologically, there is an inflammatory infiltrate in otherwise benign gastric and esophageal mucosa. We report four cases of IPFC in children, all associated with reflux esophagitis. In two patients who underwent repeat endoscopy, acid suppression therapy led to a decrease in the size of the polyp and histologic improvement of esophagitis. Four case studies in children with IPFC are presented, followed by a literature review of this endoscopic finding as it applies to children.

Effects of Proton Pump Inhibitors on Pediatric Inflammatory Esophagogastric Polyps

“…The prevalence of IEPs in children has been reported to be 2 and 8% in children with esophagitis [3]. In this study, it was 9.8% in children with reflux esophagitis; reflux esophagitis was found in all patients with IEPs.…”

“…The term IEP is used for a sentinel polyp, sentinel fold, inflammatory polyp-fold complex, inflammatory fibrous polyp, inflammatory fibroid polyp, prominent esophagogastric fold, eosinophilic granuloma, pseudotumor at the esophagogastric junction and retrograde gastric mucosal prolapse [3,4,5,6,7,8]. IEPs were first described in 1978 by Bleshman et al [4], and first reported in children in 1979 [5].…”

“…The polyp and fold at the esophagogastric junction are temporally related; it has been suggested that the polyp follows the development of the fold, and a pseudotumor may stimulate the polyp-fold complex. They all have a similar etiology, and there is no clear distinction among them [3]. …”

Multiple Esophageal Hyperplastic Polyps in a Nigerian Woman

“…A few cases of hyperplastic polyps have been found in the cervical esophagus, usually in association with ectopic gastric mucosa [4,16,17]. Polyps at the EGJ may be located at the end of a prominent inflamed gastric fold of mucosa, also known as "the sentinel fold", seen in reflux esophagitis [4,6,18].…”

“…The optimal treatment strategy is still to be defined. While some anecdotal reports showed regression of polyps after a course of anti-secretory therapy such as proton pump inhibitors [5,18], others have not demonstrated regression [14,18,22]. The minimum duration of anti-secretory therapy for polyp regression has also not been established.…”