Prevalence of Barrett Esophagus in Adolescents and Young Adults With Esophageal Atresia
To study the prevalence of Barrett esophagus (BE) (gastric and/or intestinal metaplasia) in adolescents treated for esophageal atresia (EA).
EA patients are at high risk of BE.
This multicenter prospective study included EA patients aged 15 to 19 years. All eligible patients were proposed an upper endoscopy with multistaged esophageal biopsies under general anesthesia. Histological suspicion of metaplasia was confirmed centrally.
One hundred twenty patients [mean age, 16.5 years (±1.4)] were included; 70% had been treated for gastroesophageal reflux disease (GERD) during infancy. At evaluation, 8% were undernourished, 41% had received antireflux surgery, and 41% presented with GERD symptoms, although only 28% were receiving medical treatment. Esophagitis was found at endoscopy in 34% and confirmed at histology in 67%. BE was suspected after endoscopy in 37% and was confirmed by histology for 43% of patients (50 gastric and 1 intestinal metaplasia). No endoscopic or histological anomalies were found at the anastomosis site. BE was not significantly related to clinical symptoms. In multivariate analysis, BE was associated with EA without fistula (P = 0.03), previous multiple antireflux surgery (P = 0.04), esophageal dilation (P = 0.04), suspicion of BE at endoscopy (P < 0.001), and histological esophagitis (P = 0.02).
Patients with EA are at high risk of persistent GERD and BE. The development of BE is related to GERD history. Long-term systematic follow-up of the esophageal mucosa including multistaged biopsies is required, even in asymptomatic patients. (NCT02495051).
Keywords: Barrett metaplasia; esophageal atresia; esophageal carcinoma; esophagitis; gastroesophageal reflux
Document Type: Research Article
Affiliations: 1: Reference Center for Congenital and Malformative Esophageal Disorders, Hôpital Jeanne de Flandre, Lille, Department of Pediatric Surgery, CHU, Strasbourg, France 2: Reference Center for Congenital and Malformative Esophageal Disorders, Hôpital Jeanne de Flandre, Lille 3: Department of Pediatric Gastroenterology, Hôpital Robert Debré, Paris, France 4: Department of Pediatric Surgery, CHU, Strasbourg, France 5: Department of Pediatric Gastroenterology, HFME, Lyon, France 6: Department of Pediatric Gastroenterology, CHU, Rennes, France 7: Department of Pediatric Surgery, CH Départemental Félix Guyon, Saint Denis-La Réunion, France 8: Department of Pediatric Gastroenterology, Hôpital Mère-Enfants Ste Justine, Montréal, Canada 9: Pediatric Surgical Service, Centre Hospitalier de Luxembourg, Luxembourg, Grand-Duché du Luxembourg 10: Department of Pediatric Gastroenterology, AZ VUB, Bruxelles, Belgium 11: Department of Pediatric Gastroenterology, CHU, Caen, France 12: Department of Pediatric Gastroenterology, Hôpital des Enfants, Toulouse, France 13: Department of Pediatric Surgery, CHU, Poitiers, France 14: Department of Pediatric Gastroenterology, Hôpital des Enfants, Bordeaux, France 15: Department of Pediatric Gastroenterology, HUDERF, Bruxelles, Belgium 16: Department of Pediatric Surgery, CHU, Angers, France 17: Department of Pediatric Gastroenterology, Hôpital Trousseau, Paris, France 18: Department of Pediatrics, CH, Le Havre, France 19: Department of Pediatric Gastroenterology, HME CHU, Nantes, France 20: Department of Gastroenterology CHC, Liège, Belgium 21: Department of Pediatric Gastroenterology and Hepatology, UCL, Cliniques Universitaires St Luc, Bruxelles, Belgium 22: Public Health, Methods in Clinical Research Team, CHU, Strasbourg, France 23: Centre Biologie Pathologie, Lille, France.
Publication date: 01 December 2016
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