G24 Twenty years of paediatric Barrett's oesophagus in southwest London: a single centre experience. (12th September 2022)

• Record Type: Journal Article
• Authors: Bhaduri, Tania; Ocholi, Attah
• Is Part Of: Frontline gastroenterology. Volume 13(2022)Supplement 1
• Page Start: A32
• Page End: A33
• Publication Date: 2022-09-12
• Subjects: Gastroenterology -- Periodicals; 616.33005
• DOI: 10.1136/flgastro-2022-bspghan.44
• Languages: English
• ISSNs: 2041-4137

Abstract

Abstract : Introduction: In adults, Barrett's oesophagus is recognised as a pre-malignant condition requiring routine surveillance for oesophageal adenocarcinoma. However, it is rare in children. Consequently, there is very little data on the epidemiology of Barrett's oesophagus and surveillance in the paediatric population. Aim: The aim of the study was to analyse the prevalence of Barrett's oesophagus in a paediatric gastroenterology tertiary centre. We describe the clinical characteristics, underlying risk factors and outcomes in these patients. Methods: We retrospectively studied children that had been diagnosed with Barrett's oesophagus over a 20-year period at our tertiary paediatric gastroenterology centre. Using electronic notes, we reviewed their demographics (age and gender), diagnosis and co-morbidities, treatment and whether there were complications associated with Barrett's oesophagus. Results: We identified 11 patients with a histological diagnosis of Barrett's oesophagus over a 20-year period. There were 8 males (73%) and 3 females (27%). The mean age of diagnosis was 12.1 ± 3.0 years. All patients had gastro-oesophageal reflux disease (GORD). In one patient Helicobacter pylori was also diagnosed. All patients had co-morbidities. The most common was oesophageal strictures (N=3; 27%), which were diagnosed prior to Barrett's oesophagus. One patient had had gastro-intestinal bleeding, another had ulcerative colitis and another had oesophageal atresia with tracheo-oesophageal fistula, oesophageal dysmotility and eosinophilic oesophagitis. Neurological conditions were common. Two patients had cerebral palsy with and without epilepsy, one child had Cri-du-chat syndrome, one child had T20p+4p deletion and another had T21 with a spinal cord lipoma and a neuropathic bladder. Eight patients (73%) had surgery prior to diagnosis of Barrett's oesophagus. These were insertion of gastrostomy (N=4), fundoplication (N=4) and oesophageal dilatation (N=4). One child had an oesophageal atresia and TOF repair, Nissens fundoplication and required oesophageal dilatations. All of the 9 patients that we were able to follow up were treated with medical management using a proton-pump inhibitor such as omeprazole or H2-Receptor antagonist such as ranitidine. Two patients underwent fundoplication and another patient required further oesophageal dilatation for stricture. All children had surveillance endoscopies follow-up or have an endoscopy planned. The average number of surveillance endoscopies was 2. The time between endoscopy ranged from 1 month to 60 months. The majority of patients (89%) had ongoing Barrett's oesophagus on follow-up endoscopies. One child had normal epithelium on subsequent endoscopy. No patients were diagnosed with oesophageal carcinoma (N=8, mean follow up 6.8 ± 6.1 years post-diagnosis). Summary: Paediatric Barrett's oesophagus is a rare disease with little data available. Although our cohort was small, there were no cases of oesophageal adenocarcinoma identified. There is probably a strong relationship between underlying GORD and Barrett's oesophagus, as previously described in the literature. Furthermore, neurological and oesophageal disorders were common. Anti-reflux medications are standard in Barrett's oesophagus and procedures such as fundoplication are common.