title: High rate of clinical and endoscopic relapse after healing of erosive peptic esophagitis in children and adolescents.
abstract: OBJECTIVE
  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.
authors.affiliation: Pediatric Gastroenterology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Erica
authors.initials: E
authors.lastname: Yamamoto
authors.forename: Helena S H
authors.initials: HS
authors.lastname: Brito
authors.forename: Silvio K
authors.initials: SK
authors.lastname: Ogata
authors.forename: Rodrigo S
authors.initials: RS
authors.lastname: Machado
authors.forename: Elisabete
authors.initials: E
authors.lastname: Kawakami
mesh_terms: D000293:Adolescent; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy; D004941:Esophagitis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D004942:Esophagitis, Peptic / Q000150:complications* / Q000188:drug therapy; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D064747:Lansoprazole / Q000627:therapeutic use*; D008297:Male; D010146:Pain / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D012008:Recurrence; D014945:Wound Healing
chemical_list: D000897:Anti-Ulcer Agents; D064747:Lansoprazole