User login
SALT LAKE CITY — Surgery is not needed for pediatric patients with gastroesophageal reflux disease to prevent the likelihood that the patient will go on to develop Barrett's esophagus or adenocarcinoma, Dr. David Gremse said.
“Since the healing rates of erosive esophagitis are high [with medical management, particularly proton pump inhibitor therapy], the decision for surgery should focus on symptom relief and quality of life,” said Dr. Gremse at the annual meeting of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.
In adults, the literature suggests that nonerosive esophagitis does not usually become erosive disease, and erosive esophagitis does not usually progress to Barrett's, said Dr. Gremse, the chair of pediatrics at the University of Nevada, Las Vegas.
It is not certain whether a young child with erosive esophagitis eventually will be at risk for adenocarcinoma because of a lifetime of acid exposure. But, at least in adults, there appears to be very little progression. In one study that followed 100 adults with erosive esophagitis for 10 years, only 1 patient went on to develop Barrett's, Dr. Gremse noted. Another 5-year study suggested a progression rate of 3% from erosive esophagitis to Barrett's.
In fact, gastroesophageal reflux disease (GERD) can probably be said to have three distinct phenotypes: nonerosive esophagitis, which is associated with reflux symptoms, erosive esophagitis, which can lead to esophageal bleeding, ulcers and/or strictures, and Barrett's esophagus, which can become adenocarcinoma, he said.
Pediatric patients with nonerosive esophagitis or low-grade erosive esophagitis can be treated with a histamine2-receptor antagonist or a proton pump inhibitor (PPI), which is much more effective, on an on-demand or intermittent basis. Those patients do not need to be set up for screening for Barrett's esophagus.
Patients with erosive disease should be treated with a PPI, he added. Studies of the treatment of children with PPIs have shown healing rates that are similar to the rates reported in adults, with complete healing reported for around 80% of patients.
SALT LAKE CITY — Surgery is not needed for pediatric patients with gastroesophageal reflux disease to prevent the likelihood that the patient will go on to develop Barrett's esophagus or adenocarcinoma, Dr. David Gremse said.
“Since the healing rates of erosive esophagitis are high [with medical management, particularly proton pump inhibitor therapy], the decision for surgery should focus on symptom relief and quality of life,” said Dr. Gremse at the annual meeting of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.
In adults, the literature suggests that nonerosive esophagitis does not usually become erosive disease, and erosive esophagitis does not usually progress to Barrett's, said Dr. Gremse, the chair of pediatrics at the University of Nevada, Las Vegas.
It is not certain whether a young child with erosive esophagitis eventually will be at risk for adenocarcinoma because of a lifetime of acid exposure. But, at least in adults, there appears to be very little progression. In one study that followed 100 adults with erosive esophagitis for 10 years, only 1 patient went on to develop Barrett's, Dr. Gremse noted. Another 5-year study suggested a progression rate of 3% from erosive esophagitis to Barrett's.
In fact, gastroesophageal reflux disease (GERD) can probably be said to have three distinct phenotypes: nonerosive esophagitis, which is associated with reflux symptoms, erosive esophagitis, which can lead to esophageal bleeding, ulcers and/or strictures, and Barrett's esophagus, which can become adenocarcinoma, he said.
Pediatric patients with nonerosive esophagitis or low-grade erosive esophagitis can be treated with a histamine2-receptor antagonist or a proton pump inhibitor (PPI), which is much more effective, on an on-demand or intermittent basis. Those patients do not need to be set up for screening for Barrett's esophagus.
Patients with erosive disease should be treated with a PPI, he added. Studies of the treatment of children with PPIs have shown healing rates that are similar to the rates reported in adults, with complete healing reported for around 80% of patients.
SALT LAKE CITY — Surgery is not needed for pediatric patients with gastroesophageal reflux disease to prevent the likelihood that the patient will go on to develop Barrett's esophagus or adenocarcinoma, Dr. David Gremse said.
“Since the healing rates of erosive esophagitis are high [with medical management, particularly proton pump inhibitor therapy], the decision for surgery should focus on symptom relief and quality of life,” said Dr. Gremse at the annual meeting of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.
In adults, the literature suggests that nonerosive esophagitis does not usually become erosive disease, and erosive esophagitis does not usually progress to Barrett's, said Dr. Gremse, the chair of pediatrics at the University of Nevada, Las Vegas.
It is not certain whether a young child with erosive esophagitis eventually will be at risk for adenocarcinoma because of a lifetime of acid exposure. But, at least in adults, there appears to be very little progression. In one study that followed 100 adults with erosive esophagitis for 10 years, only 1 patient went on to develop Barrett's, Dr. Gremse noted. Another 5-year study suggested a progression rate of 3% from erosive esophagitis to Barrett's.
In fact, gastroesophageal reflux disease (GERD) can probably be said to have three distinct phenotypes: nonerosive esophagitis, which is associated with reflux symptoms, erosive esophagitis, which can lead to esophageal bleeding, ulcers and/or strictures, and Barrett's esophagus, which can become adenocarcinoma, he said.
Pediatric patients with nonerosive esophagitis or low-grade erosive esophagitis can be treated with a histamine2-receptor antagonist or a proton pump inhibitor (PPI), which is much more effective, on an on-demand or intermittent basis. Those patients do not need to be set up for screening for Barrett's esophagus.
Patients with erosive disease should be treated with a PPI, he added. Studies of the treatment of children with PPIs have shown healing rates that are similar to the rates reported in adults, with complete healing reported for around 80% of patients.