Managing gastroesophageal reflux disease in children: The role of endoscopy

Abstract

Gastroesophageal reflux disease (GERD) is a growing problem in the pediatric population and recent advances in diagnostics and therapeutics have improved their management, particularly the use of esophago-gastroduodenoscopy (EGD). Most of the current knowledge is derived from studies in adults; however there are distinct features between infant onset and adult onset GERD. Children are not just little adults and attention must be given to the stages of growth and development and how these stages impact the disease management. Although there is a lack of a gold standard test to diagnose GERD in children, EGD with biopsy is essential to assess the type and severity of tissue damage. To date, the role of endoscopy in adults and children has been to assess the extent of esophagitis and detect metaplastic changes complicating GERD; however the current knowledge points another role for the EGD with biopsy that is to rule out other potential causes of esophagitis in patients with GERD symptoms such as eosinophilic esophagitis. This review highlights special considerations about the role of EGD in the management of children with GERD.

Keywords: Children; Endoscopy; Esophagitis; Gastroesophageal reflux; Infants.

Figure 1

Endoscopy findings. A: Endoscopy of a child with esophagitis Los Angeles grade A showing one mucosal break < 5 mm in length; B: Another child with Los Angeles grade B showing 3 mucosal breaks > 5 mm long not continuous between the tops of adjacent mucosal folds; C: Endoscopy of a child with esophagitis Los Angeles grade D with mucosal break that involves at least 75% of the luminal circumference; D: Another 14-year-old patient with Barrett esophagus showing an area of endoscopically suspected esophageal metaplasia.