Pediatric Esophageal Disorders: Diagnosis and Treatment of Reflux and Eosinophilic Esophagitis

Adamiak, Tonya; Plati, Karen Francolla

doi:10.1542/pir.2017-0266

Cited by 11 publications

(6 citation statements)

References 81 publications

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“…None of the cases studied reported a predisposing factor such as cardiomegaly, esophageal motility disorders, stenosis, gastroesophageal reflux, achalasia, or infectious esophagitis 4 . The lesions, characterized by different size ulcers, were found in the mid esophagus similar to the sites of the previous reports [2][3][4]7 .…”

Section: Discussionsupporting

confidence: 85%

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L-arginine-induced esophagitis, report of six cases

Parra¹,

González-Cruz²,

Ferreiro-Marín³

et al. 2020

BMHIM

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Background: Drug-induced esophagitis is an uncommon diagnosis in the pediatric population. The following is a report of six adolescents with L-arginine-induced esophagitis. Case reports: All patients were under treatment with L-arginine for short stature. After using the prescribed medication for 1-3 months, all cases started with severe retrosternal pain, odynophagia, and dysphagia. The upper gastrointestinal endoscopies showed ulcers located in the mid esophageal mucosa. Conclusions: In the presence of acute severe odynophagia, dysphagia, and retrosternal pain, drug-induced esophagitis should be considered as a possible diagnosis. Treatment includes liquid diet, pain control, sucralfate, omeprazole, and interruption of L-arginine.In addition, the physician should explain preventive measures focused on patient and family education on the drug side effects and precise instructions on how to take medications, as well as a careful balance of risk and benefits of any medication. At present, there are no clinical trials that support the use of L-arginine in treatment of short stature.

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Section: Discussionsupporting

confidence: 85%

“…Several oral medications may cause tissue damage such as L-arginine. Patient and family information about possible medication side effects, appropriate fluid intake with the pill, and avoiding lying down 30 min after taking the pill, should help to reduce this type of injury to the esophageal mucosa 6,7 .…”

Section: Discussionmentioning

confidence: 99%

L-arginine-induced esophagitis, report of six cases

Parra¹,

González-Cruz²,

Ferreiro-Marín³

et al. 2020

BMHIM

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“…Other disorders affecting the esophagus in children include eosinophilic esophagitis, achalasia, esophageal dysmotility, and congenital malformations, including tracheoesophageal fistula, esophageal atresia, and diaphragmatic hernia. Esophageal motility is an important component of these disorders and motility testing may play a crucial role in helping to differentiate these conditions (3)(4)(5)(6).…”

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confidence: 99%

Endoluminal Functional Lumen Imaging Probe Is Safe in Children Under Five Years Old

Hoskins¹,

Almazan

Mogul³

et al. 2022

J. pediatr. gastroenterol. nutr.

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Background:Endoluminal functional lumen imaging probe (EndoFLIP) is a minimally invasive, novel device that uses high-resolution impedance planimetry to measure important parameters of the gastrointestinal lumen that aid in the diagnosis of esophageal disorders. EndoFLiP is approved by the US Food and Drug Administration (FDA) for children 5 years and older. We sought to compare its safety and luminal characteristics between children under 5 years of age with children 5 years and older.Methods:A single-center retrospective review was performed to identify all patients < 21 years of age who underwent esophagogastroduodenoscopy (EGD) with EndoFLIP between October 2017 and November 2020. Results: Sixty-seven EGDs with EndoFLIP were performed in 56 patients, including 14 that were done in children < 5 years and 53 in children ≥5years. The median age in the < 5-year group was 1.7years (interquartile range [IQR], 0.9–4.4) and the youngest patient was 1 month old. The median age in ≥5-year group was 14.3 years (IQR, 8.2–16.2). Median procedure times were similar (32 minutes [IQR, 25–48] for the < 5-year group; 28 minutes [IQR, 20–33] for ≥5-year group; P = 0.08). There were no adverse events or unplanned hospitalizations in either group. At 30 mL inflation, the pressure of the lower esophageal sphincter (LES) was statistically different between the 2 groups (P = 0.02).Conclusion:EndoFLIP appears to be safe for use in our small cohort of children < 5 years of age and may be an important tool in the management of esophageal disorders in this age group. There was no difference in procedure time between our 2 age groups and there were no procedure-related complications.

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“…2,6 The symptoms of EoE vary with age (vomiting, eating disorders, and failure to thrive in infants and preschool-aged children; dysphagia, food impaction, and heartburn in older children and adolescents). 7 It should be noted that a high percentage of patients may manifest respiratory symptoms, such as cough and sleep disorders. 8 Patients with a diagnosis of EoE have a higher prevalence of rhinitis, asthma, and eczema than the general population.…”

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confidence: 99%

Corticosteroids for Eosinophilic Esophagitis in Children: A Meta-analysis

et al. 2020

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CONTEXT: Treatment of eosinophilic esophagitis (EoE) is focused on dietary, pharmacologic, and endoscopic therapy options. Within the pharmacologic alternatives, topical corticosteroids are the most used, and a large number of studies evaluating their effectiveness have been published, requiring a new summary of evidence. OBJECTIVE: To evaluate the histologic and clinical effectiveness of the use of corticosteroids in pediatric patients with a diagnosis of EoE. DATA SOURCES: Cochrane Central Register of Controlled Trials, Medline, Embase, Science Citation Index Expanded, Conference Proceedings Citation Index-Science, Latin American and Caribbean Health Sciences Literature, and ClinicalTrials.gov (June 2019). STUDY SELECTION: We selected randomized controlled trials assessing corticosteroids versus a placebo or dietary treatment of EoE in children. DATA EXTRACTION: Methodologic quality of evidence was evaluated by using the Cochrane Collaboration’s risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation system. The primary outcomes were clinical and histologic improvement. RESULTS: A total of 1655 studies were identified. Five studies were included (206 patients). Histologic response was 49.25% in the corticosteroids group and 4.16% in the placebo group (risk ratio 11.05 [confidence interval 3.8–32.15]; P < .0001). Symptomatic response was 33.6% in the corticosteroids group and 21.8% in the control group (risk ratio 1.62 [confidence interval 0.94–2.79]; P = .08). There were no major adverse effects. LIMITATIONS: Heterogeneity of the diagnosis of EoE. CONCLUSIONS: Our review revealed favorable results of corticosteroids versus placebo, mainly in histologic response. More studies are needed, by using validated clinical scores, to obtain more reliable results.

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Pediatric Esophageal Disorders: Diagnosis and Treatment of Reflux and Eosinophilic Esophagitis

Cited by 11 publications

References 81 publications

L-arginine-induced esophagitis, report of six cases

L-arginine-induced esophagitis, report of six cases

Endoluminal Functional Lumen Imaging Probe Is Safe in Children Under Five Years Old

Corticosteroids for Eosinophilic Esophagitis in Children: A Meta-analysis

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