Factors Affecting the Prevalence of Gastro-oesophageal Reflux in Childhood Corrosive Oesophageal Strictures

Year 2014, Volume: 2014 Issue: 2, 137 - 142, 07.08.2014

Serdar H. İskit Zerrin Özçelik Murat Alkan Selcan Türker Ünal Zorludemir

https://doi.org/10.5152/balkanmedj.2014.13276

Abstract

Background: Gastro-oesophageal reflux may accompany the corrosive oesophageal damage caused by the ingestion of corrosive substances and affect its treatment. The factors that affect the development of reflux in these cases and their effects on treatment still remain unclear. Aims: Our aim is to investigate the prevalence of gastro-oesophageal reflux in children with corrosive oesophageal strictures, the risk factors affecting this prevalence and the effects of gastro-oesophageal reflux on treatment. Study Design: Case-control study. Methods: We enrolled 52 patients with oesophageal stricture due to corrosive substance ingestion who were referred to our clinic between 2003 and 2010. Groups, which were determined according to the presence of gastro-oesophageal reflux (GER), were compared with each other in terms of clinical findings, results of examination methods, characteristics of the stricture and success of the treatment. Results: The total number of patients in our study was 52; 30 of them were male and 22 of them were female. The mean age of our study population was 4.2±2.88 years. Thirty-three patients had gastro-oesophageal reflux (63.5%). Patients who had strictures caused by the ingestion of alkali substances were 1.6-times more likely to have reflux. There were no differences between patients with or without reflux in terms of number and localisation of strictures. Mean distance of stricture was longer in patients with reflux (3.7±1.8 cm) than in patients without (2.2±1.0 cm) (p<0.005). Only one patient among 17 who had a long stricture (≥4 cm) did not suffer from reflux. Patients with long stricture were 1.9-times more likely to have reflux. Dilatation treatment was successful in 69.6% of patients with reflux and in 78.9% of patients without. The mean treatment period was 8.41±6.1 months in patients with reflux and 8.21±8.4 months in the other group. There was no significant difference between groups in terms of frequency of dilatation and dilator diameters (p>0.05). Conclusion: Corrosive oesophageal stricture was usually accompanied by gastro-oesophageal reflux and the length of stricture is an important risk factor. Negative effects of reflux over dilatation treatment have not yet been demonstrated in the short-term. Nevertheless, this frequent rate of reflux may eventually increase the risk of oesophagitis and Barrett's oesophagus; therefore, we suggest that these effects should be prospectively evaluated in a large number of patients and these patients should be followed-up routinely in terms of the long-term effects of reflux.

Keywords

Corrosive oesophageal burns, gastro-oesophageal reflux, oesophageal pH monitor­ing, oesophagitis

Factors Affecting the Prevalence of Gastro-oesophageal Reflux in Childhood Corrosive Oesophageal Strictures

Abstract

References

• Erdoğan E, Eroğlu E, Tekant G, Yeker Y, Emir H, Sarımurat N, et al. Management of esophagogastric corrosive injuries in children. Eur J Pediatr Surg 2003;13:289-93. [CrossRef]
• Gün F, Abbasoğlu L, Çelik A, Salman FT. Early and late term manage- ment in caustic ingestion in children: a 16-year experience. Acta Chir Belg 2007;107:49-52.
• Chang CF, Kuo SP, Lin HC, Chuang CC, Tsai TK, Wu SF, et al. En- doscopic balloon dilatation for esophageal strictures in children younger than 6 years: experience in a medical center. Pediatr Neonatol 2011;52:196-202. [CrossRef]
• Panieri E, Rode H, Millar AJW, Cywes S. Oesophageal replacement in the management of corrosive strictures: when is surgery indicated? Pe- diatr Surg Int 1998;13:336-340. [CrossRef]
• Da-Costa-Pinto EAL, Dorsa TK, Altimani A, Andreollo NA, Cardoso SR, Morais DJ, et al. A functional study of caustic strictures of the esopagus in children. Braz J Med Biol Res 2004;37:1623-30. [CrossRef]
• Mutaf O, Geç A, Herek Ö, Demircan M, Özcan C, Arikan A. Gastro- esophageal reflux: a determinant in the outcome of caustic esophageal burns. J Pediatr Surg 1996;31:1494-5. [CrossRef]
• Özcan Z, Özcan C, Erinç R, Dirlik A, Mutaf O. Scintigraphy in the de- tection of gastroesophageal reflux in children with caustic oesophageal burns: a comparative study with radiography and 24-h pH monitoring. Pediatr Radiol 2001;31:737-41. [CrossRef]
• Bautista A, Varela R, Villanueva A, Estevez E, Tojo R, Cadranel S. Motor function of the esophagus after caustic burn. Eur J Pediatr Surg 1996;6:204-7. [CrossRef]
• Bautista A, Martinez EE, Cives RV, Jeremias AV, Tojo R, Cadranel S. A retrospective analysis of ingestion of caustic substances by children. Ten-year statistics in Galicia. Eur J Pediatr 1997;156:410-4. [CrossRef]
• Capella M, Goldberg P, Quaresma E, Araujo E, Pereime M. Persistance of corrosive esophageal stricture due to gastroesophageal reflux in chil- dren. Pediatr Surg Int 1992;7:180-2.[CrossRef]
• Genç A, Mutaf O. Esophageal motility changes in acute and late periods of caustic esophageal burns and their relation to prognosis in children. J Pediatr Surg 2002;37:1526-8. [CrossRef]
• Dantas RO, Mamede RC. Esophageal motility in patients with esopha- geal caustic injury. Am J Gastroenterol 1996;91:1157-61.