BARRETT-ESOPHAGUS IN CHILDREN AND ADOLESCENTS

This paper describes 12 cases of Barrett's oesophagus (BE) selected out of a population of 364 refluxing children studied by X-ray, manometric, pH-metric, endoscopic, and bioptic methods in one single institution from 1986 to 1990. Their mean age was 14 years, the male-female ratio was 5:7, and all had had gastro-oesophageal reflux (GER) symptoms since infancy. At the time of diagnosis 9 (75%) had vomiting, 6 (50%) respiratory tract disease, 3 (25%) haemorrhage, and 1 (8%) peptic stenosis. Seven were cared for in special institutions for brain-damaged patients and 2 had been operated upon for oesophageal atresia at birth. Lower oesophageal sphincter pressure was very low in 8 out of 9 children studied and propulsive peristalsis was markedly decreased. Excessive acid exposure was documented in 8 out of 10 patients studied and simultaneous gastric and oesophageal pH-monitoring demonstrated massive duodeno-gastric alkaline reflux in 3 (2 of them with ''normal'' oesophageal pH studies). Histological and histochemical studies, including special mucin staining, revealed that the columnar-lined epithelium was of the fundic type in 2 cases, the junctional type in 7, and the specialised type in the remaining 3. Helicobacter pylori was found in the mucosa of 8 patients (in massive amounts in 3). All patients had a Nissen fundoplication with good results in terms of disappearance of the GER symptoms. The present series confirms that BE should be looked for endoscopically in children with GER and supports the hypothesis that long duration of GER and excessive acid-alkaline chemical exposure of the oesophageal lining contribute to the pathogenesis of mucosal changes. The role of H. pylori is not clear, but its intriguing presence in the majority of our cases indicates that further research along these lines is warranted.