Peptic oesophageal stricture in children: Management problems

Abstract

Background: Peptic oesophageal stricture (PES) is a serious complication of gastroesophageal reflux disease (GERD) in childhood. The treatment of PES is still controversial, ranging from simple oesophageal dilations to resection/anastomosis of the stenotic portion of the oesophagus. In this  study, we want to share our experience with 11 children with GERD and PES.

Patients and Methods: A retrospective review of clinical data obtained from children who underwent dilation and antirefl ux surgery for PES was performed.

Results: A total of 11 patients were diagnosed with PES. The clinical picture was dominated by dysphagia. Barium swallow showed hiatal hernia in nine cases (82%). Oesophageal strictures were located most commonly in the  lower third of the oesophagus (91%). Three Children (27%) with PES had a neurologic impairment and patients had a mean duration of symptoms of  20 months (range, 3 month to 6.2 years) before intervention. Children received a median of four dilations (range, 1-21 dilations) for PES. Time to fi rst dilation from age of diagnosis was a mean of 4.5 months (range,
2-14 months). Antireflux surgery was performed in all patients.  Post-operatively, seven patients required repeat oesophageal dilation. Patients were followed with serial dilation for a median of 6 years (range, 1-9 years) and only one patient has a continued requirement of  oesophageal dilation for PES.

Conclusion: 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.

Key words: Childhood, dilation, gastroesophageal reflux disease, peptic oesophageal stricture, surgery