Erosive lesions of the esophagus in schoolchildren

Introduction. Gastroesophageal reflux disease (GERD) is a common disease characterized by the ingestion of stomach contents into the esophagus, causing symptoms and/or complications. According to various authors, the prevalence of signs of erosive esophagitis in GERD children patients, is 10–50%. Further study of the prevalence and clinical manifestations of erosive esophagitis in children is an urgent task.

Purpose: to study the prevalence of erosive esophagitis in schoolchildren with clinical manifestations of dyspepsia.

Materials and methods. We examined five hundred ninety six children patients who underwent primary gastroenterological exa­mination for persistent signs of dyspepsia. The comparison group consisted of 30 children aged to 18 years. All children underwent endoscopic examination using a GIF XP-20 apparatus from Olympus (Japan). Esophagitis was diagnosed according to the Los Angeles classification.

Results. The prevalence of erosive changes in the esophagus in the examined patients was 17.4%. Erosive lesions of the esophagus occurred with equal prevalence in patients of primary and secondary school age. Boys predominate among patients with erosive esophagitis. Erosive esophagitis at the stage A was detected more often — 90.4%, less often at stages B — 7.7% and C — 1.9%, esophagitis in stage D was not detected in any of the cases.

Conclusion. The main clinical manifestations of erosive esophagitis are abdominal pain, heartburn, belching, and nausea. The features of the clinical course depending on the stage of esophagitis were established.

Contributions:
Latyshev D.Yu., Tekutyeva N.A. — concept and design of the study;
Latyshev D.Yu., Prokudina M.P., Martirosyan M.S., Pimenova D.V. — collection and processing of material;
Latyshev D.Yu., Tekutyeva N.A., Prokudina M.P. — statistical processing of the material;
Latyshev D.Yu., Lobanov Yu.F., Martirosyan M.S., Pimenova D.V. — text writing;
Lobanov Yu.F., Mikheeva N.M., Strozenko L.A. — editing.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The work was not supported financially.

Conflict of interests. The authors declare no conflict of interest.

Received: May 26, 2022 
Accepted: June 10, 2022
Published: July 15, 2022

1. Quitadamo P., Papadopoulou A., Wenzl T., Urbonas V., Kneepkens C.M., Roman E., et al. European pediatricians’ approach to children with GER symptoms: survey of the implementation of 2009 NASPGHAN-ESPGHAN guidelines. J. Pediatr. Gastroenterol. Nutr. 2014; 58(4): 505–9. https://doi.org/10.1097/MPG.0b013e3182a69912

2. Rosen R., Vandenplas Y., Singendonk M., Cabana M., DiLorenzo C., Gottrand F., et al. Pediatric gastroesophageal reflux clinical practice guidelines. J. Pediatr. Gastroenterol. Nutr. 2018; 66(3): 516–54. https://doi.org/10.1097/MPG.0000000000001889

3. Ivashkin V.T., Maev I.V., Trukhmanov A.S., Lapina T.L., Storonova O.A., Zayrat’yants O.V., et al. Recommendations of the Russian Gastroenterological Association in diagnosis and treatment of gastroesophageal reflux disease. Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii. 2020; 30(4): 70–97. https://doi.org/10.22416/1382-4376-2020-30-4-70-97 (in Russian)

4. Delshad S.D., Almario C.V., Chey W.D., Spiegel B.M.R. Prevalence of gastroesophageal reflux disease and proton pump inhibitor-refractory symptoms. Gastroenterology. 2020; 158(5): 1250–61.e2. https://doi.org/10.1053/j.gastro.2019.12.014

5. GBD 2017 Gastro-oesophageal Reflux Disease Collaborators. The global, regional, and national burden of gastro-oesophageal reflux disease in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol. Hepatol. 2020; 5(6): 561–81. https://doi.org/10.1016/S2468-1253(19)30408-X

6. Shikh E.V. Gastroesophageal Reflux Disease [Gastroezofageal’naya reflyuksnaya bolezn’]. Moscow; 2019. (in Russian)

7. Bel’mer S.V., Volynets G.V., Gorelov A.V., Gurova M.M., Zvyagin A.A., Kornienko E.A., et al. Functional digestive disorders in children. Guidelines of Society of Pediatric Gastroenterologists, Hepatologists and Nutritionists. Part 1. Rossiyskiy vestnik perinatologii i pediatrii. 2020; 65(4): 150–61. https://doi.org/10.21508/1027-4065-2020-65-4-150-161 (in Russian)

8. Singendonk М., Goudswaard Е., Langendam М., van Wijk М., van Etten-Jamaludin F., Benninga М., et al. Prevalence of gastroesophageal reflux disease symptoms in infants and children: a systematic review. J. Pediatr. Gastroenterol. Nutr. 2019; 68(6): 811–7. https://doi.org/10.1097/MPG.0000000000002280

9. Gonzalez J.I., Hauser B., Salvatore S., Vandenplas Y. Diagnosis and management of gastroesophageal reflux disease in infants and children: from guidelines to clinical practice. Pediatr. Gastroenterol. Hepatol. Nutr. 2019; 22(2): 107–21. https://doi.org/10.5223/pghn.2019.22.2.107

10. Eusebi L.H., Ratnakumaran R., Yuan Y., Solaymani-Dodaran R., Bazzoli F., Ford A.C. Global prevalence of and risk factors for gastroesophageal reflux symptoms: a meta-analysis. Gut. 2018; 67(3): 430–40. https://doi.org/10.1136/gutjnl-2016-313589

11. Kaybysheva V.O., Kashin S.V., Mikhaleva L.M., Vidyaeva N.S., Kuvaev R.O., Galkova Z.V., et al. Eosinophilic esophagitis: current view on the problem and own clinical observations. Dokazatel’naya gastroenterologiya. 2019; 8(1-1): 58–83. https://doi.org/10.17116/dokgastro2019801158 (in Russian)

12. Tarasova G.N., Smirnova E.A. Pathogenetic features of contamination of the esophagus mucosa in gastroesophageal reflux disease. Consilium Medicum. 2017; 19(8-2): 7–12. https://doi.org/10.26442/2075-1753_19.8.2.7-12 (in Russian)

13. Bardou М., Fortinsky J.К., Chapelle N., Luu М., Barkun А. An update on the latest chemical therapies for reflux esophagitis in children. Expert Opin. Pharmacother. 2019; 20(2): 231–9. https://doi.org/10.1080/14656566.2018.1549224

14. Kaybysheva V.O., Kucheryavyy Yu.A., Trukhmanov A.S., Storonova O.A., Kon’kov M.Yu., Maev I.V., et al. The results of a multicenter observational study on the use of the international GerdQ questionnaire for the diagnosis of gastroesophageal reflux disease. Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii. 2013; 23(5): 15–24. (in Russian)

15. Polivanova T.V., Kasparov E.V., Vshivkov V.A. Age-related features of gastritis activity in schoolchildren with gastroesophageal reflux disease. Rossiyskiy pediatricheskiy zhurnal. 2022; 25(2): 116–20. https://doi.org/10.46563/1560-9561-2022-25-2-116-120 (in Russian)

16. Gilger M.A., El-Serag H.B., Gold B.D., Dietrich C.L., Tsou V.M., McDuffie A., et al. Prevalence of endoscopic findings of erosive esophagitis in children: a population-based study. J. Pediatr. Gastroenterol. Nutr. 2008; 47(2): 141–6. https://doi.org/10.1097/MPG.0b013e31815eeabe

17. Okimoto Е., Ishimura N., Morito Y., Mikami H., Shimura Sh., Uno G., et al. Prevalence of gastroesophageal reflux disease in children, adults, and elderly in the same community. J. Gastroenterol. Hepatol. 2015; 30(7): 1140–6. https://doi.org/10.1111/jgh.12899

18. Mukhametova E.M., Erdes S.I. Gastroesophageal reflux disease in children: epidemiology, diagnostic criteria, prognosis. Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii. 2010; 20(1): 75–81. (in Russian)

19. Kim Y.S., Kim N., Kim G.H. Sex and gender differences in gastroesophageal reflux disease. J. Neurogastroenterol. Motil. 2016; 22(4): 575–88. https://doi.org/10.5056/jnm16138

20. Kharitonova A.Yu., Smirnov I.E., Shavrov A.A., Kalashnikova N.A., Lokhmatov M.M. Current technologies in the endoscopic diagnosis of erosive-ulcerative lesions in the upper gastrointestinal tract of children. Rossiyskiy pediatricheskiy zhurnal. 2010; (3): 32–5. (in Russian)

21. Kharitonova A.Yu., Shavrov A.A., Smirnov I.E., Kalashnikova N.A. Narrow-band imaging endoscopy in the diagnosis of destructive changes in the mucous membrane of the stomach and duodenum in children. Rossiyskiy pediatricheskiy zhurnal. 2012; 15(6): 20–4. (in Russian)

22. Sherman P.M., Hassall E., Fagundes-Neto U., Gold B.D., Kato S., Koletzko S., et al. A global, evidence-based consensus on the definition of gastroesophageal reflux disease in the pediatric population. Am. J. Gastroenterol. 2009; 104(5): 1278–95. https://doi.org/10.1038/ajg.2009.129

23. Lundell L.R., Dent J., Bennett J.R., Blum A.L., Armstrong D., Galmiche J.P., et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999; 45(2): 172–80. https://doi.org/10.1136/gut.45.2.172

24. El-Serag H.B., Bailey N.R., Gilger M., Rabeneck L. Endoscopic manifestations of gastroesophageal reflux disease in patients between 18 months and 25 years without neurological deficits. Am. J. Gastroenterol. 2002; 97(7): 1635–9. https://doi.org/10.1111/j.1572-0241.2002.05820.x

25. Chiu J.Y., Wu J.F., Ni Y.H. Correlation between gastroesophageal reflux disease questionnaire and erosive esophagitis in school-aged children receiving endoscopy. Pediatr. Neonatol. 2014; 55(6): 439–43. https://doi.org/10.1016/j.pedneo.2014.01.004

26. Gupta S.K., Hassall E., Chiu Y.L., Amer F., Heyman M.B. Presenting symptoms of nonerosive and erosive esophagitis in pediatric patients. Dig. Dis. Sci. 2006; 51(5): 858–63. https://doi.org/10.1007/s10620-006-9095-3

27. Lee J.J., Baker R.D., Khan A.R., Baker S.S. Childhood esophagitis: then and now. J. Pediatr. Gastroenterol. Nutr. 2009; 48(1): 37–40. https://doi.org/10.1097/MPG.0b013e31817c0399