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The abdomen
Published in Spencer W. Beasley, John Hutson, Mark Stringer, Sebastian K. King, Warwick J. Teague, Paediatric Surgical Diagnosis, 2018
Spencer W. Beasley, John Hutson, Mark Stringer, Sebastian K. King, Warwick J. Teague
Almost all babies have gastro-oesophageal reflux, which becomes less pronounced during the first year of life. Severe gastro-oesophageal reflux in the first month of life may be pronounced enough to raise suspicion of pyloric stenosis, but no pyloric tumour will be palpable or seen on ultrasonography. Severe gastro-oesophageal reflux may produce complications, which in themselves demand surgical correction of the reflux. The most important are life-threatening apnoeic episodes. An oesophageal stricture may develop secondary to oesophagitis from the corrosive effect of gastric acid reflux into the lower oesophagus. In infants, gastro-oesophageal reflux may lead to respiratory problems such as pneumonia from aspiration of gastric contents. Oesophagitis may produce dysphagia, bleeding - either haematemesis or melaena - and iron-deficiency anaemia. In a small group of infants, reflux is responsible for failure to thrive. Gastro-oesophageal reflux may occur in isolation or be associated with other conditions, both medical (e.g. severe neurological impairment, Down syndrome) and surgical (e.g. congenital hiatal hernia or after repair of oesophageal atresia, exomphalos major or congenital diaphragmatic hernia).
Esophageal atresia and tracheo-esophageal fistula
Published in Prem Puri, Newborn Surgery, 2017
The incidence of anastomotic leak following repair of EA and TEF ranges from 11% to 21%.48,75 This is usually manifested by pneumothorax and salivary drainage from the chest drain. It is rare for the anastomosis to be completely disrupted. Provided that a transanastomotic tube is in place, it is usually possible to control the leak with an adequately sized chest drain. With adequate drainage, broad-spectrum antibiotics, and total parenteral nutrition, the esophagus will usually heal, although a prolonged period with a chest tube may be necessary. Some surgeons have used hyoscine patches in an attempt to “dry up” the salivary leak. Others advocate early re-exploration (<48 hours), with direct repair of the esophagus if possible, and the establishment of satisfactory drainage where a major leak is suspected.13,75,76 When conservative management fails with uncontrolled sepsis, the establishment of a cervical esophagostomy and a feeding gastrostomy are essential. The child is committed to esophageal replacement at a later date. A clinical anastomotic leak predisposes to the development of an esophageal stricture.77 While this association may seem logical, others contest such a correlation.75
Esophageal and Gastric Bleeding
Published in John F. Pohl, Christopher Jolley, Daniel Gelfond, Pediatric Gastroenterology, 2014
Esophageal instrumentation, for example with nasogastric tube placement or therapeutic endoscopy, can cause mucosal trauma and bleeding. Often this bleeding is self-limited and intervention is not necessary aside from supportive care. Long-term complications can include esophageal stricture formation.
Efficacy of bougie dilation for normal diet in benign esophageal stricture
Published in Scandinavian Journal of Gastroenterology, 2023
Jun Young Park, Jae Myung Park, Ga-Yeong Shin, Joon Sung Kim, Yu Kyung Cho, Tae Ho Kim, Byung-Wook Kim, Myung-Gyu Choi
Esophageal stricture is an abnormal narrowing of the esophageal lumen. The most common symptom associated with esophageal stricture is difficulty in swallowing solid foods [1–3]. Benign esophageal stricture (BES) is caused by mucosal injury such as reflux esophagitis, post-radiation therapy, ingestion of corrosive agents, post-endoscopic procedure or -surgery [4]. Among them, peptic stricture is the most common cause of benign esophageal strictures, which account for about 70% of cases. Endoscopic treatment is known to be effective for peptic stricture [5]. However, the increasing use of proton pump inhibitors (PPIs) has led to a relative decrease in their incidence [1]. Nowadays, esophageal strictures from malignancy, post-surgery, caustic ingestion, radiation therapy, wide mucosectomy, eosinophilic esophagitis and Schatzki rings are increasingly encountered [1,6].
Estimation of the risk of local and systemic effects in infants after ingestion of low-concentrated weak acids from descaling products
Published in Clinical Toxicology, 2022
Arjen Koppen, Claudine C. Hunault, Regina G. D. M. van Kleef, Agnes G. van Velzen, Remco H. S. Westerink, Irma de Vries, Dylan W. de Lange
Local effects of acids are well known and described [3]. The severity of tissue damage due to acids depends on pH, the amount and the contact time of the acidic solution with tissue. The severity of injury can also be predicted by the titratable acid/alkaline reserve, i.e. the buffer capacity of an acidic solution [4]. In general, acid solutions with a pH of 2 or lower are considered to be strong corrosives, and exposure to these chemicals can result in severe burns, lesions and coagulation necrosis [5]. This latter effect reduces tissue penetration by acids, usually resulting in less tissue damage compared to caustic agents like alkaline chemicals [3]. Ingestion of acids may induce burns throughout the gastrointestinal tract, mainly esophageal, gastric and/or duodenal lesions. Eventually, esophageal stricture formation may occur due to scarring. In case of oral exposure to weak acids as found in household descaling products, it is not clear whether local tissue damage is likely to occur, especially when descalers are diluted and/or supplemented with baby milk powder.
Emerging drugs for eosinophilic esophagitis
Published in Expert Opinion on Emerging Drugs, 2018
Robert D. Pesek, Sandeep K. Gupta
Studies of reslizumab have demonstrated similar results. In a study by Spergel et al. [90] of 226 children and adolescents randomized to receive four monthly infusions of reslizumab or placebo, treated subjects had significant reductions in peak esophageal eosinophils, up to 67%, compared to only 24% of controls. As with mepolizumab, there were no significant differences between the groups in regard to symptom improvement. In an open label extension of this trial, 12 subjects received reslizumab monthly for a median duration of three years with three subjects receiving treatment for nine years [91]. About 92% of these subjects demonstrated a reduction in peak esophageal eosinophil counts to <5/hpf. There were significant improvements in all reported symptoms compared to baseline and no subjects developed evidence of esophageal stricture.