Esophageal Inlet Patch: An Under-Recognized Cause of Symptoms in Children.
To determine the incidence of inlet patch (IP) and to assess the clinical and pathological features, role of the diagnostic workup in treatment decision making, efficacy of medical and endoscopic therapy, and natural history in a pediatric population.



Consecutive patients aged <18 years (n = 1000) undergoing esophagogastroduodenoscopy were enrolled prospectively. Biopsy specimens were obtained from IPs and the proximal and distal esophagus, stomach, and duodenum. Multichannel intraluminal impedance and pH monitoring (MII-pH) was performed in all symptomatic patients. Symptomatic patients were treated with proton pump inhibitors for 8 weeks, and IP ablation by argon plasma coagulation (APC) was performed in unresponsive patients.



The endoscopic incidence of IP was 6.3%, with a cumulative missing rate of 5.8%. Thirty-five of the 63 patients (56%) were asymptomatic, 11 (17%) had symptoms clearly related to the underlying digestive disorder, and 17 (27%) had chronic IP-related symptoms. MII-pH was positive in 10 of the 28 symptomatic patients. All 17 patients with IP-related symptoms were unresponsive to proton pump inhibitors and were treated with APC, and all had achieved complete remission by the 3-year follow-up. Patients with underlying disorders were successfully treated with medical therapy, and asymptomatic patients remained symptom-free, with no endoscopic or histological changes seen at the 3-year follow-up.



IP is an under-recognized cause of symptoms in children with unexplained esophageal and respiratory symptoms. MII-pH and bioptic sampling are needed to exclude entities mimicking IP symptoms and to direct therapy. APC is safe and effective for treating IP-related symptoms.
Pediatric Unit, Orvieto Hospital, Orvieto, Italy; Pediatric Gastroenterology Unit, International Hospital Salvator Mundi, Rome, Italy. Electronic address: giovanni.dinardo3@alice.it.
Giovanni
G
Di Nardo
Department of Medical and Surgical Sciences, University of Bologna, St Orsola-Malpighi Hospital, Bologna, Italy.
Cesare
C
Cremon
Department of Medical and Surgical Sciences, University of Bologna, St Orsola-Malpighi Hospital, Bologna, Italy.
Luca
L
Bertelli
Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, Rome, Italy.
Salvatore
S
Oliva
Department of Medical and Surgical Sciences, University of Bologna, St Orsola-Malpighi Hospital, Bologna, Italy.
Roberto
R
De Giorgio
Department of Medical and Surgical Sciences, University of Bologna, St Orsola-Malpighi Hospital, Bologna, Italy.
Nico
N
Pagano
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002828:Choristoma / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D004935:Esophageal Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D005753:Gastric Mucosa; D005773:Gastroscopy; D006801:Humans; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use
D054328:Proton Pump Inhibitors
argon plasma coagulator; children; dysphagia; extraesophageal symptoms; globus sensation; inlet patch