Chronic esophagitis in children

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

Read also: Chronic esophagitis

[1], [2], [3], [4], [5], [6], [7]

What causes chronic esophagitis in children?

The immediate cause of the development of chronic esophagitis is gastroesophageal reflux - recurring pellets of stomach contents into the esophagus. The cause of gastroesophageal reflux can be:

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

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

1. alimentary: irregular meals, fast food changes, eating dry, overeating, abuse of refined foods, pork and lamb fat, coarse fiber, mushrooms, spices, eating too hot and cold food;
2. heavy physical exertion, vibration, overheating;
3. neuropsychic disorders;
4. environmental causes (the state of drinking water, the presence of xenobiotics in food, the content of nitrates in the soil);
5. taking medications (cholinolytics, sedatives, hypnotics, nitrates, theophylline, beta-blockers, calcium channel blockers, etc.);
6. smoking;
7. food allergy.

Pathogenesis of chronic esophagitis

At the heart is the casting of aggressive gastric contents into the esophagus, which can have a damaging effect on the mucous membrane. They matter:

• frequency (more than 3 episodes per day) and duration of gastroesophageal reflux;
• slowing the speed with which the esophagus is able to release from the acid to be thrown (acidification of the esophagus for more than 5 minutes), due to:
  • violations of active peristalsis of the esophagus (esophagus dyskinesia, esophagospasm);
  • decrease alkalinization of saliva and mucus, weakening of 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 sternum). Heartburn usually increases after errors in the diet (oily, fried foods, coffee, carbonated drinks), overeating.
• pain behind the sternum, behind the xiphoid process, usually have a paroxysmal character, can radiate into the heart, neck, interscapular space.
• burping of air, sour, bitter (an impurity of bile), at night as a result of regurgitation a "spot on the pillow" can appear.
• often respiratory disorders (laryngospasm, apnea in children of the first months of life, bronchospasm, night attacks of bronchial asthma, repeated pneumonia) as a result of exposure to the receptors of the middle and upper third of the esophagus, and aspiration of gastric contents.

Classification of chronic esophagitis

In accordance with the endoscopic classification, Savary and Miller distinguish four degrees of esophagitis:

• I degree - hyperemia of the distal esophagus;
• II degree - erosion of the esophagus, not merging with each other;
• III degree - merging erosion;
• IV degree - chronic ulcer of the esophagus, stenosis.

[8], [9], [10], [11], [12]

Diagnosis of chronic esophagitis in children

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

Prolonged pH-metry of the esophagus (pH monitoring - "Gastroscan-24") allows you to assess the frequency, duration and severity of reflux. Normally, the pH in the esophagus is 7.0-7.5, with reflux - 4.0 and lower.

X-ray examination of the esophagus with barium makes it possible to assess the rate of passage of contrast mass along the esophagus, its tone, the presence of regurgitation, and diaphragmatic hernia.

[13], [14], [15]

Differential diagnosis of chronic esophagitis in children

Peptic ulcer of the esophagus usually occurs with Barrett's disease (congenital short esophagus). Characteristic intense chest pains, dysphagia, often vomiting with blood or latent bleeding, leading to anemia. Diagnose endoscopically.

Stenosis of the esophagus - persistent vomiting and regurgitation immediately after eating, weight loss, are detected radiological or endoscopically.

Congenital achalasia of the esophagus. The first symptoms (dysphagia, regurgitation) appear in children older than 3-5 years. With endoscopy (or fluoroscopy) of the esophagus, there is an absence of relaxation when swallowing the lower esophageal sphincter in the state of hypertension.

[16], [17], [18], [19], [20], [21], [22], [23]

Treatment of chronic esophagitis in children

Recommended diet and lifestyle regimen:

1. avoid abundant food, do not eat at night;
2. after eating for 1.5-2 hours do not lie down, do not work in an inclined position;
3. limit the intake of products that lower the tone of the lower esophageal sphincter (fats, fried, coffee, chocolate, citrus, carbonated drinks), and also containing coarse fiber (fresh onions, garlic, cabbage, peppers, radish);
4. to give up smoking;
5. sleep with a raised (at 15 cm) head end of the bed;
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 inhibitors, theophylline, prostaglandins, nitrates).

Medical treatment of chronic esophagitis in children is aimed at:

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

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

Antisecretory agents are indicated in erosive-ulcerative esophagitis. Apply H2-histaminoblockers of II or III generations (ranitidine or famotidine) or inhibitors of H ⁺ -K ⁺ -ATPase (omeprazole, lancepresol, pantoprozole), course 2-4 weeks.

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

The choice of the therapy scheme depends on the severity of the esophagitis:

• at I degree - prokinetics + antacids, course 2 weeks;
• at the II degree - Н2-histaminoblockers + prokinetics, course 2-4 weeks;
• at III-IV degrees - inhibitors of H ⁺ K ⁺ ATPase + prokinetics, up to 4-6 weeks.

How to prevent chronic esophagitis in children?

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