Tuesday, February 7, 2023

Pediatric Esophagitis

Background

Esophagitis (inflammation of the squamous esophageal epithelium) may result from various causes, including acid and nonacid gastroesophageal reflux (GER), food allergies, dysmotility due to various causes, infections, trauma, and iatrogenic causes. In the pediatric population, gastroesophageal reflux disease (GERD), infection, eosinophilic esophagitis, and corrosive ingestions account for most cases. (See Pathophysiology and Etiology.)

The clinical presentation depends on the etiology. Bleeding or upper airway obstruction with hemodynamic compromise and perforation of the esophagus or stomach are the most significant immediate complications. Over the long term, all types of esophagitis can be complicated by the development of strictures. (See Clinical Presentation.)

In infants, GER may be difficult to differentiate from colic. Treatment often includes therapy for excessive gas or changing of formulas, especially because parents may note pain and crying, pulling up of legs, and abdominal distention. (See Diagnosis.)

Few laboratory studies are helpful for the diagnosis of esophagitis. Esophagogastroduodenoscopy (EGD) is performed to allow more definitive visualization of the esophageal mucosa. Biopsy samples are always obtained to look for histologic confirmation. An upper gastrointestinal (GI) study should be considered in all patients with persistent emesis and in whom esophagitis is suspected. (See Workup.)

Specific treatment for esophagitis varies with the etiology. Symptomatic treatment may include antacids for mild reflux esophagitis or viral esophagitis in the immunocompetent host. Hospitalization is required if patients have significant bleeding, hemodynamic compromise, obstruction, perforation, or respiratory distress or are unable to feed themselves. (See Treatment and Management, as well as Medication.)

Go to Esophagitis for more complete information on this topic.

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