Reflux oesophagitis in children; the role of endoscopy. A multicentric Italian survey.
BACKGROUND
The decision whether to perform endoscopy in children with suspected reflux oesophagitis is not a straightforward one. Few symptoms are specific for oesophagitis and the diagnosis is not always correlated even to visual findings on endoscopy.


OBJECTIVE
The aim of this study was to define the role of endoscopy and especially of histology in the diagnosis of reflux oesophagitis and to examine the correlations between symptoms, endoscopic findings and histology in children with suspected gastroesophageal reflux disease.


METHODS
One hundred and thirty-six patients with a clinical diagnosis of reflux oesophagitis, aged 1-18 years (mean 8.43; standard deviation +/-4.4), were enrolled from 12 Italian Paediatrics Gastroenterology Centres; symptom score, endoscopic and histologic oesophagitis scores were observed before and after therapy with proton pump inhibitors.


RESULTS
Before therapy, a high correlation between the prevailing symptom score and endoscopic score was demonstrated, but not with histologic score: there was a significant tendency for histologic grade to exceed visual findings. After therapy, endoscopic score and histologic score were significantly improved.


CONCLUSIONS
Oesophageal biopsies increase the diagnostic accuracy of upper endoscopy. Histologic grading is often much more important than the endoscopic appearance, so that endoscopic oesophageal biopsies are very important aids in the diagnosis of oesophagitis. Appropriate clinical evaluation of symptoms must occur before endoscopic examination.
Lombardi
G
G
Paediatric Gastroenterology Unit, Spirito Santo Hospital, Via Fonte Romana 8, 65100 Pescara, Italy. dolomb@tin.it
de' Angelis
G
G
Rutigliano
V
V
Guariso
G
G
Romano
C
C
Falchetti
D
D
Pittschieler
K
K
Brunero
M
M
Lerro
P
P
Sabbi
T
T
Pepe
G
G
De Venuto
D
D
Torroni
F
F
Bizzarri
B
B
Di Nicola
M
M
Di Mascio
R
R
Dall'Oglio
L
L
D000293:Adolescent; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016099:Endoscopy, Gastrointestinal; D004942:Esophagitis, Peptic / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D009853:Omeprazole / Q000627:therapeutic use
D000897:Anti-Ulcer Agents; D009853:Omeprazole