Presenting Symptoms of Nonerosive and Erosive Esophagitis in Pediatric Patients
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Children and adolescents with symptomatic gastroesophageal reflux disease (GERD) and erosive esophagitis (EE) of grade ≥2 (n=45) or nonerosive esophagitis (NEE) (n=45) were assessed to determine the relationship between presenting symptoms, esophagitis severity, and patient age. Overall, regurgitation/vomiting, abdominal pain, and cough were the most frequent symptoms. The prevalence and severity of anorexia/feed refusal was significantly greater in EE versus NEE children; this symptom was also significantly more prevalent in younger (1–5 years) children (both NEE and EE groups) compared to older children. Cough was significantly less severe in NEE adolescents than in younger children. Cough, anorexia/feed refusal, and regurgitation/vomiting were more severe and heartburn was less severe in EE children aged 1–5 years compared with older patients. In conclusion, GERD in children manifests differently than that in adults and symptoms vary with patient age. Symptoms were not predictive of presence or lack of mucosal damage.
Keywords:Children Adolescents Gastroesophageal reflux disease Nonerosive reflux disease Erosive esophagitis Feeding problems Cough Abdominal pain
This study was supported by a grant from TAP Pharmaceutical Products Inc., Lake Forest, Illinois (TAP Studies: M97-808 & M97-640). M.B.H. is supported by NIH Grant DK 060617. We thank Susan Ruffalo, PharmD, of MedWrite, Inc., for consolidating and incorporating the authors’ comments and for creating the figures.
These data were presented at the Annual Meeting of the American Gastroenterological Association 2001.
We thank the children and parents for their participation in this study and the study nurses/coordinators for their diligent efforts. Participating centers included (L. Book) University of Utah, Salt Lake City, Utah; (D, Gremse) University of South Alabama, Mobile, Alabama; (T. Gunasekaran) Lutheran General Children's Hospital, Park Ridge, Illinois; (M.B. Heyman) University of California—San Francisco, San Francisco, California; (R. Kane, III) Cardinal Glennon Children's Hospital, St. Louis, Missouri; (R. Steffen) Cleveland Clinic Foundation, Cleveland, Ohio; (V. Tolia) Children's Hospital of Michigan, Detroit, Michigan; (H. Winter) Mass General Hospital for Children, Boston, Massachusetts; (G. Ferry) Texas Children's Hospital, Houston, Texas; (S. Gupta) Riley Hospital for Children, Indianapolis, Indiana; (S. Czinn) Rainbow Babies and Children's Hospital, Cleveland, Ohio; and (R. Torres-Pinedo) Digestive Disease Research Institute, Oklahoma City, Oklahoma.
- 2.Orenstein SR (2004) Gastroesophageal reflux. In: Walker WA, Goulet O, Kleinman RE, Sanderson IR, Sherman PM, Shneider BL (eds) Pediatric gastrointestinal disease: pathophysiology, diagnosis, management. 4th ed. BC Decker Inc, Hamilton, Ontario, pp 513–534Google Scholar
- 3.Rudolph CD, Mazur LJ, Liptak GS, Baker RD, Boyle JT, Colletti RB, Gerson WT, Werlin SL (2001) Guidelines for evaluation and treatment of gastroesophageal reflux in infants and children: recommendations of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr 32:S1–S31CrossRefPubMedGoogle Scholar
- 6.Ramesh P, Braden D, Dey S, Gunasekaran TS (2002) Prevalence of gastroesophageal reflux disease [GERD] symptoms in a Caucasian predominant adolescent population. Gastroenterology 122:A213Google Scholar
- 7.Nelson SP, Chen EH, Syniar GM, Christoffel KK, for the Pediatric Practice Research Group (2000) Prevalence of symptoms of gastroesophageal reflux during childhood: a pediatric practice-based survey. Arch Pediatr Adolesc Med 154:150–154Google Scholar
- 10.Voutilainen M, Sipponen P, Mecklin JP, Juhola M, Farkkila M (2000) Gastroesophageal reflux disease: prevalence, clinical, endoscopic and histopathological findings in 1,128 consecutive patients referred for endoscopy due to dyspeptic and reflux symptoms. Digestion 61:6–13CrossRefPubMedGoogle Scholar
- 12.Ismail-Beigi F, Horton PF, Pope CE (1970) Histological consequences of gastroesophageal reflux in man. Gastroenterology 58:163–174Google Scholar
- 20.Treem WR, Davis PM, Hyams JS (1991) Gastroesophageal reflux in the older child: presentation, response to treatment and long-term follow-up. Clin Pediatr 30:435–440Google Scholar