Chronic esophagitis in children

Chronic esophagitis is an inflammatory-dystrophic lesion of the mucous membrane of the esophagus. In the structure of diseases of the digestive organs, chronic esophagitis accounts for 11-17%.

Read also: Chronic esophagitis

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What causes chronic esophagitis in children?

The immediate cause of chronic esophagitis is gastroesophageal reflux - recurrent reflux of stomach contents into the esophagus. Gastroesophageal reflux can be caused by:

1. diseases of the gastroesophageal region:
   • lower esophageal sphincter insufficiency;
   • hernia of the esophageal opening of the diaphragm;
   • congenital short esophagus (Barrett's disease);
2. neurocirculatory dysfunction, often with vagotonia;
3. spinal diseases (scoliosis, osteochondrosis, etc.).

The following factors can contribute to the development of gastroesophageal reflux:

1. alimentary: irregular meals, rapid changes in meals, eating dry food, overeating, abuse of refined foods, pork and lamb fat, coarse fiber, mushrooms, spices, consumption of food that is too hot or cold;
2. heavy physical exertion, vibrations, overheating;
3. neuropsychiatric disorders;
4. environmental reasons (the state of drinking water, the presence of xenobiotics in food, the content of nitrates in the soil);
5. taking medications (anticholinergics, sedatives, sleeping pills, nitrates, theophylline, beta-blockers, calcium channel blockers, etc.);
6. smoking;
7. food allergy.

Pathogenesis of chronic esophagitis

The basis is the reflux of aggressive gastric contents into the esophagus, which can have a damaging effect on the mucous membrane. The following are important:

• frequency (more than 3 episodes per day) and duration of gastroesophageal reflux;
• slowing down the rate at which the esophagus is able to clear itself of refluxed acid (esophageal acidification for more than 5 minutes), due to:
  • disorders of active peristalsis of the esophagus (esophageal dyskinesia, esophageal spasm);
  • reducing the alkalizing effect of saliva and mucus, weakening the local bicarbonate barrier and regeneration of the mucous membrane.

Symptoms of chronic esophagitis in children

The main symptoms of chronic esophagitis in children:

• heartburn (a burning sensation in the epigastrium and behind the breastbone). Heartburn usually intensifies after dietary errors (fatty, fried foods, coffee, carbonated drinks), overeating.
• pain behind the sternum, behind the xiphoid process, usually paroxysmal in nature, can radiate to the heart area, neck, interscapular space.
• belching of air, sour, bitter (admixture of bile), at night as a result of regurgitation a “spot on the pillow” may appear.
• often respiratory disorders (laryngospasm, apnea in children in the first months of life, bronchospasm, nocturnal attacks of bronchial asthma, repeated pneumonia) due to both the effect on the receptors of the middle and upper third of the esophagus and aspiration of gastric contents.

Classification of chronic esophagitis

According to the endoscopic classification of Savary and Miller, four degrees of esophagitis are distinguished:

• Grade I - hyperemia of the distal esophagus;
• II degree - erosions of the esophagus that do not merge with each other;
• III degree - merging erosions;
• IV degree - chronic ulcer of the esophagus, stenosis.

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Diagnosis of chronic esophagitis in children

The main method for diagnosing esophagitis is endoscopic, which allows one to assess the condition of the cardia and the mucous membrane of the esophagus and take a targeted biopsy.

Long-term pH-metry of the esophagus (pH-monitoring - "Gastroscan-24") allows to evaluate the frequency, duration and severity of reflux. Normally, pH in the esophagus is 7.0-7.5, with refluxes - 4.0 and below.

X-ray examination of the esophagus with barium allows one to assess the speed of passage of the contrast mass through the esophagus, its tone, the presence of regurgitation, and diaphragmatic hernia.

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Differential diagnosis of chronic esophagitis in children

Peptic ulcer of the esophagus usually occurs with Barrett's disease (congenital short esophagus). Characterized by intense chest pain, dysphagia, often vomiting blood or hidden bleeding, leading to anemia. Diagnosed endoscopically.

Esophageal stenosis - persistent vomiting and regurgitation immediately after eating, weight loss, detected radiologically or endoscopically.

Congenital achalasia of the esophagus. The first symptoms (dysphagia, regurgitation) appear in children over 3-5 years old. Endoscopy (or X-ray) of the esophagus reveals the absence of relaxation during swallowing of the lower esophageal sphincter, which is in a state of hypertonicity.

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Treatment of chronic esophagitis in children

They recommend adjusting your diet and lifestyle:

1. avoid large meals, do not eat at night;
2. after eating, do not lie down for 1.5-2 hours, do not work in a bent position;
3. limit consumption of foods that reduce the tone of the lower esophageal sphincter (fats, fried foods, coffee, chocolate, citrus fruits, carbonated drinks), as well as those containing coarse fiber (fresh onions, garlic, cabbage, peppers, radishes);
4. quit smoking;
5. sleep with the head of the bed raised (15 cm);
6. do not wear tight belts;
7. Avoid taking medications that reduce the tone of the lower esophageal sphincter (anticholinergics, sedatives, tranquilizers, beta-blockers, calcium channel blockers, theophylline, prostaglandins, nitrates).

Drug treatment of chronic esophagitis in children is aimed at:

1. reduction of gastric juice aggression (antacids and antisecretory drugs);
2. normalization of esophageal motility (prokinetics).

Selective antacids for the treatment of reflux esophagitis are drugs containing algic acid - topalkan (topal) and protab, which settle on the surface of the mucous membrane of the esophagus. Antacids are usually prescribed 3-4 times a day 1 - 1.5 hours after meals and at night, and additionally - for heartburn and chest pain.

Antisecretory agents are indicated for erosive-ulcerative esophagitis. H2-histamine blockers of the second or third generation (ranitidine or famotidine) or H ⁺ -K ^+- ATPase inhibitors (omeprazole, lanceprozole, pantoprazole) are used, the course is 2-4 weeks.

Prokinetics increase the tone of the lower esophageal sphincter and accelerate evacuation from the stomach. Dopa receptor blockers are used (metoclopramide, motilium at the rate of 1 mg/kg/day in 3 doses 30 minutes before meals); cholinomimetics (cisapride, coordinax, prepulsid at the rate of 0.5 mg/kg/day).

The choice of treatment regimen depends on the severity of esophagitis:

• in case of I degree - prokinetics + antacids, course 2 weeks;
• for stage II - H2-histamine blockers + prokinetics, course 2-4 weeks;
• at stages III-IV - H ⁺ K ⁺ ATPase inhibitors + prokinetics, in a course of up to 4-6 weeks.

How to prevent chronic esophagitis in children?

Chronic esophagitis in children can be prevented by early detection and treatment of gastroesophageal reflux, and optimization of nutrition and lifestyle.