High Rate of Clinical and Endoscopic Relapse After Healing of Erosive Peptic Esophagitis in Children and Adolescents

High Rate of Clinical and Endoscopic Relapse After Healing of Erosive Peptic Esophagitis in Children and Adolescents

Author Yamamoto, Erica Autor UNIFESP Google Scholar
Brito, Helena S. H. Autor UNIFESP Google Scholar
Ogata, Silvio Kazuo Autor UNIFESP Google Scholar
Machado, Rodrigo S. Autor UNIFESP Google Scholar
Kawakami, Elisabete Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Abstract Objectives: the aim of the present study was to estimate the rate of clinical and endoscopic relapse after initial treatment of erosive peptic esophagitis in children and adolescents. Methods: A total of 24 patients (2.1-16.4 years old, mean standard deviation [SD] 9.9 +/- 3.1; male:female 3) with healed endoscopic erosive esophagitis and without gastroesophageal reflux disease (GERD)- predisposing conditions were followed up for 4 to 32.9 months (mean 20.8 +/- 10.6 years). Structured clinical evaluation was performed every other week during the initial treatment and maintenance, and every 3 months after that. Whenever a clinical relapse happened, a new endoscopic evaluation was performed. Severity and frequency were scored on 10-point and 6-point semiquantitative scales, respectively. Results: At baseline, epigastric pain was the most reported symptom (70.8%), with intensity scored as >5 in 88.3% of patients, and median frequency of 3 (weekly; daily in 5, 20.8%). Clinical relapse was detected in 20 of 24 (83.3%) patients after a median period of 14.65 months (95% confidence interval [CI] 6.7-25.7 months). Endoscopic relapse was observed in 9 of 20 (45%) patients after a median of 25.7 months. the dose of lansoprazole needed to heal the esophagitis was not significantly associated with the risk for clinical relapse (hazard ratio [HR] 1.74, 0.94, 7.72, P = 0.06), whereas the body mass index (BMI) was directly associated with endoscopic relapse (HR 1.3, 1, 1.69, P = 0.05). Conclusions: Children with healed erosive esophagitis have up to 83% clinical relapse and of the 83%, 45% had endoscopic relapse. Correlation of endoscopic relapse with clinical symptom is poor. Higher grades of esophagitis and higher BMI are risk factors for endoscopic relapse.
Keywords esophagitis
gastroesophageal reflux disease
lansoprazole
Language English
Date 2014-11-01
Published in Journal of Pediatric Gastroenterology and Nutrition. Philadelphia: Lippincott Williams & Wilkins, v. 59, n. 5, p. 594-599, 2014.
ISSN 0277-2116 (Sherpa/Romeo, impact factor)
Publisher Lippincott Williams & Wilkins
Extent 594-599
Origin http://dx.doi.org/10.1097/MPG.0000000000000499
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000344511800010
URI http://repositorio.unifesp.br/handle/11600/38358

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