eMedicine Specialties > Pediatrics: General Medicine > Gastroenterology

Esophagitis: Follow-up

Author: Jessica Wen, MD, Clinical Fellow, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia
Coauthor(s): Andrew S Chu, MD, Medical Director, CHOP Connection at Grand View Hospital, Children's Hospital of Philadelphia; Clinical Assistant Professor, Division of General Pediatrics, Department of Pediatrics, University of Pennsylvania School of Medicine; Maria Rebello Mascarenhas, MBBS, Associate Professor of Pediatrics, University of Pennsylvania School of Medicine; Section Chief, Division of Gastroenterology and Nutrition, Director, Nutrition Support Service, Children's Hospital of Philadelphia; Vera De Matos, MD, Fellow in Pediatric Gastroenterology, The Children's Hospital of Philadelphia, University of Pennsylvania
Contributor Information and Disclosures

Updated: Mar 5, 2008

Follow-up

Further Inpatient Care

  • Hospitalization is required if patients have significant bleeding, hemodynamic compromise, obstruction, perforation, or respiratory distress or are unable to feed themselves.
  • Following a caustic ingestion, most children need to be admitted at least for observation to keep them on nothing by mouth (NPO) status, provide intravenous hydration until endoscopy, and monitor vital signs and respiratory distress.
  • If no mucosal burns are detected, a patient may be discharged home after tolerating a normal diet. For patients with first-degree burns only, observe for at least 48-96 hours and until tolerating a normal diet. Patients with second- and third-degree burns require prolonged hospitalization.

Further Outpatient Care

  • Close monitoring with the primary physician after caustic ingestion is important in the early detection and intervention of stricture formation. Among patients who develop strictures, 50% develop them in 1 month, 80% develop them in 2 months, and all patients develop them by 8 months.
  • Late esophageal squamous carcinoma is rare.

Inpatient & Outpatient Medications

  • H2-receptor antagonists and PPIs may be used for the ongoing management of reflux esophagitis. The duration of treatment depends on severity of esophagitis and response to therapy.
  • Antibiotic, antiviral, or antifungal therapy may be indicated for infectious esophagitis.
  • Corticosteroid use may be considered in patients with severe inflammation to possibly decrease the incidence of (but not prevent) stricture formation. The use of corticosteroids in allergic esophagitis may also be beneficial, but only after an unsuccessful trial with an adequate elimination diet.

Transfer

  • Consider transferring patients with hemodynamic instability, severe bleeding, or respiratory distress to a facility with intensive care monitoring. Specialists experienced in pediatric endoscopy and surgery are also required.

Deterrence/Prevention

  • Prevention of accidental ingestion is critical to prevent the potentially high associated morbidity and mortality. Corrosive agents should be locked up and kept out of reach of young children and maintained in their closed original containers.

Complications

  • Bleeding or upper airway obstruction with hemodynamic compromise and perforation of the esophagus or stomach are the most significant immediate complications.
  • Apnea, chronic respiratory illnesses including asthma, and failure to thrive are not rare complications of reflux esophagitis. Barrett esophagus or adenocarcinoma is rare.
  • Abnormal motility, obstruction, perforation, strictures, fistula formation, secondary bacterial infections, and hemorrhage are complications of infectious esophagitis.
  • The long-term complications of corrosive esophagitis include perforation, secondary bacterial infections (aspiration pneumonia, peritonitis, mediastinitis, sepsis), altered motility, and obstruction with stricture formation.

Prognosis

  • The prognosis for esophagitis depends on the etiology and any underlying medical conditions.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Reflux esophagitis
    • The frequency of reflux esophagitis is somewhat debatable because irritability could be the presenting symptom in an infant with gastroesophageal reflux (GER). This condition may be difficult to differentiate from colic. Treatment often includes therapy for excessive gas or changing formulas, especially because parents may note pain and crying, pulling up of legs, and abdominal distention.
    • Although most cases of colic self-resolve and require only conservative measures, a minority of infants may benefit from reflux therapy, specifically antacids or H2 antagonists. This is true especially if a history of frequent regurgitation or other characteristic posturing is noted by the parent or physician.
    • Before beginning motility agents (eg, Reglan), be certain to document that upper GI anatomy is normal.
  • Corrosive esophagitis
    • Be certain to have a low threshold for admitting a child to the hospital, even if just for observation, following any caustic ingestion.
    • Do not be falsely reassured by the quantity of the ingestion. Significant burns have followed minimal exposures, such as licking the bottle cap of a container that holds an alkali and eating from an unwashed spoon that had been used to measure liquid lye.
    • Esophageal burns do not always correlate with the presence of oral lesions or burns. In one study, almost 50% of patients with no oral lesions had esophageal burns, whereas only slightly more than 50% of patients with oral lesions also had esophageal lesions.

Special Concerns

  • Infectious esophagitis
    • For the patient with cancer (immunocompromised), esophagitis may have multiple etiologies. Clinically, noninfectious and infectious causes may be difficult to distinguish. Consequently, antireflux, antifungal, antiviral, and antibiotic therapies are often instituted.
    • Chemotherapy, radiation therapy, emesis, acid reflux, and bacterial colonization may be contributors to mucosal injury, although fungal and viral causes are usually considered first.
    • In certain cases, esophagoscopy with biopsy may assist in the management of infectious esophagitis. The absolute neutrophil count (ANC) or presence of oropharyngeal colonization does not necessarily predict the cause of the esophagitis.
 


More on Esophagitis

Overview: Esophagitis
Differential Diagnoses & Workup: Esophagitis
Treatment & Medication: Esophagitis
Follow-up: Esophagitis
References
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References

  1. Gold BD. Gastroesophageal reflux disease: could intervention in childhood reduce the risk of later complications?. Am J Med. Sep 6 2004;117 Suppl 5A:23S-29S. [Medline].

  2. Boccia G, Manguso F, Miele E et el. Maintenance therapy for erosive esophagitis in children after healing by Omeprazole: is it advisable?. Am J Gastroenterol. Jun 2007;102(6):1291-7. [Medline].

  3. Spergel JM. Eosinophilic esophagitis in adults and children: evidence for a food allergy component in many patients. Curr Opin Allergy Clin Immunol. June 2007;7(3):274-8. [Medline].

  4. Liacouras CA, Wenner WJ, Brown K, Ruchelli E. Primary eosinophilic esophagitis in children: successful treatment with oral corticosteroids. J Pediatr Gastroenterol Nutr. Apr 1998;26(4):380-5. [Medline].

  5. Noel RJ, Rothenberg ME. Eosinophilic esophagitis. Curr Opin Pediatr. Dec 2005;17(6):690-4. [Medline].

  6. Arnold L, Liacouras CA. Foreign bodies and caustic ingestions. In: Altschuler SM, Liacouras CA, eds. Clinical Pediatric Gastroenterology. Philadelphia, Pa: Churchill Livingstone; 1998:25-9.

  7. Azimi PH, Willert J, Petru A. Severe esophagitis in a newborn infant. Pediatr Infect Dis J. Apr 1996;15(4):385. [Medline].

  8. Berezin S, Glassman MS, Bostwick H, Halata M. Esophagitis as a cause of infant colic. Clin Pediatr (Phila). Mar 1995;34(3):158-9. [Medline].

  9. Cadranel S, Di Lorenzo C, Rodesch P, et al. Caustic ingestion and esophageal function. J Pediatr Gastroenterol Nutr. Feb 1990;10(2):164-8. [Medline].

  10. Chitkara DK, Fortunato C, Nurko S. Esophageal motor activity in children with gastro-esophageal reflux disease and esophagitis. J Pediatr Gastroenterol Nutr. Jan 2005;40(1):70-5. [Medline].

  11. Committee on Infectious Diseases. Candidiasis. In: 2006 Red Book: Report of the Committee on Infectious Diseases. American Academy of Pediatrics; 2006:242-6.

  12. Committee on Infectious Diseases. Cytomegalovirus infection. In: 2006 Red Book: Report of the Committee on Infectious Diseases. 27th ed. American Academy of Pediatrics; 2006:273-7.

  13. Committee on Infectious Diseases. Antifungal drugs for systemic fungal infection. In: 2006 Red Book: Report of the Committee on Infectious Diseases. 27th ed. American Academy of Pediatrics; 2006:774-6.

  14. Committee on Infectious Diseases. Antiviral drugs for non-human immunodeficiency virus infections. In: 2006 Red Book: Report of the Committee on Infectious Diseases. 27th ed. American Academy of Pediatrics; 2006:785-9.

  15. Committee on Infectious Diseases. Herpes simplex. In: 2006 Red Book: Report of the Committee on Infectious Diseases. 27th ed. American Academy of Pediatrics; 2006:361-71.

  16. Deneyer M, Goossens A, Pipeleers-Marichal M, et al. Esophagitis of likely traumatic origin in newborns. J Pediatr Gastroenterol Nutr. Jul 1992;15(1):81-4. [Medline].

  17. Faubion WA Jr, Zein NN. Gastroesophageal reflux in infants and children. Mayo Clin Proc. Feb 1998;73(2):166-73. [Medline].

  18. Furuta GT, Liacouras CA, Collins MH, Gupta SK, Justinich C, Putnam PE. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology. Oct 2007;133(4):1342-63. [Medline].

  19. Goff JS. Infections. In: Walker WA, Durie PR, Hamilton JR, eds. Pediatric Gastrointestinal Disease: Pathophysiology, Diagnosis, Management. 2nd ed. Mosby-Year Book; 1996:454-60.

  20. Gryboski, JD. Traumatic injury of the esophagus. In: Walker WA, Durie PR, Hamilton JR, eds. Pediatric Gastrointestinal Disease: Pathophysiology, Diagnosis, Management. 2nd ed. Mosby-Year Book; 1996:430-53.

  21. Henretig FM, Shannon M. Toxicologic emergencies. In: Textbook of Pediatric Emergency Medicine. 3rd ed. Baltimore, Md: Williams and Wilkins; 1993:771-3.

  22. Herbst JJ. Esophagitis. In: Behrman RE, Kliegman R, Jenson HB, eds. Nelson Textbook of Pediatrics. 16th ed. Philadelphia, Pa: WB Saunders Co; 1999:1126-7.

  23. Hillemeier AC. Gastroesophageal reflux and esophagitis. In: Walker WA, Durie PR, Hamilton JR, eds. Pediatric Gastrointestinal Disease: Pathophysiology, Diagnosis, Management. 2nd ed. Mosby-Year Book; 1996:461-8.

  24. Hogan SP, Rothenberg ME. Review article: The eosinophil as a therapeutic target in gastrointestinal disease. Aliment Pharmacol Ther. Dec 2004;20(11-12):1231-40. [Medline].

  25. Isaac DW, Parham DM, Patrick CC. The role of esophagoscopy in diagnosis and management of esophagitis in children with cancer. Med Pediatr Oncol. Apr 1997;28(4):299-303. [Medline].

  26. Israel DM, Hassall E. Omerprazole and other proton pump inhibitors: pharmacology, efficacy, and safety, with special reference to use in children. J Pediatr Gastroenterol Nutr. Nov 1998;27(5):568-79. [Medline].

  27. Lake DE, Kunzweiler J, Beer M, et al. Fluconazole versus amphotericin B in the treatment of esophageal candidiasis in cancer patients. Chemotherapy. Jul-Aug 1996;42(4):308-14. [Medline].

  28. Liacouras CA, Ruchelli E. Eosinophilic esophagitis. Curr Opin Pediatr. Oct 2004;16(5):560-6. [Medline].

  29. Moulin D, Bertrand JM, Buts JP, et al. Upper airway lesions in children after accidental ingestion of caustic substances. J Pediatr. Mar 1985;106(3):408-10. [Medline].

  30. Noel RJ, Tipnis NA. Eosinophilic esophagitis -- a mimic of GERD. Int J Pediatr Otorhinolaryngol. Jul 2006;70(7):1147-53. [Medline].

  31. Orenstein SR, Izadnia F, Khan S. Gastroesophageal reflux disease in children. Gastroenterol Clin North Am. Dec 1999;28(4):947-69. [Medline].

  32. Esophageal reflux. In: Walker WA, Goulet O, Kleinman RE, et al, eds. Pediatric Gastrointestinal Disease. 4th ed. Lewiston, NY: BC Decker; 2004:400-24.

  33. Rodrigues F, Brandao N, Duque V, et al. Herpes simplex virus esophagitis in immunocompetent children. J Pediatr Gastroenterol Nutr. Nov 2004;39(5):560-3. [Medline].

  34. Rothstein FC. Caustic injuries to the esophagus in children. Pediatr Clin North Am. Jun 1986;33(3):665-74. [Medline].

  35. Ruchelli ED, Liacouras CA. Esophageal disorders in childhood. In: Russo P, Ruchelli E, Piccoli DA, eds. Pathology of Pediatric Gastrointestinal and Liver Disease. New York, NY: Springer-Verlag; 2004:37-46.

  36. Spitz L, Lakhoo K. Caustic ingestion. Arch Dis Child. Feb 1993;68(2):157-8. [Medline].

  37. Vandenplas Y, Badriul H, Verghote M, Hauser B, Kaufman L. Oesophageal pH monitoring and reflux oesophagitis in irritable infants. Eur J Pediatr. Jun 2004;163(6):300-4. [Medline].

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Further Reading

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Keywords

esophagitis, inflammation of esophagus, esophagus inflammation, gastroesophageal reflux, GER, corrosive ingestion, reflux esophagitis, peptic esophagitis, corrosive esophagitis, caustic esophagitis, eosinophilic esophagitis, radiation esophagitis, Barrett esophagus, candidal esophagitis, Sandifer syndrome, gastroesophageal reflux disease, GERD, lower esophageal sphincter, LES, EE, esophagogastroduodenoscopy, EGD, pediatric esophagitis, acid reflux, food allergy, chemical esophagitis, infectious esophagitis, acid GER, nonacid GER, poison ingestion, household cleaner ingestion, accidental ingestion, herpes simplex virus, HSV, cytomegalovirus, CMV, allergic esophagitis, Nissen fundoplication, histamine 2–receptor antagonist, prokinetic agent, proton pump inhibitor

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Contributor Information and Disclosures

Author

Jessica Wen, MD, Clinical Fellow, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia
Jessica Wen, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Study of Liver Diseases, American Medical Association, and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition
Disclosure: Nothing to disclose.

Coauthor(s)

Andrew S Chu, MD, Medical Director, CHOP Connection at Grand View Hospital, Children's Hospital of Philadelphia; Clinical Assistant Professor, Division of General Pediatrics, Department of Pediatrics, University of Pennsylvania School of Medicine
Andrew S Chu, MD is a member of the following medical societies: American Academy of Pediatrics and Society of Hospital Medicine
Disclosure: Nothing to disclose.

Maria Rebello Mascarenhas, MBBS, Associate Professor of Pediatrics, University of Pennsylvania School of Medicine; Section Chief, Division of Gastroenterology and Nutrition, Director, Nutrition Support Service, Children's Hospital of Philadelphia
Maria Rebello Mascarenhas, MBBS is a member of the following medical societies: American Gastroenterological Association, American Society for Parenteral and Enteral Nutrition, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

Vera De Matos, MD, Fellow in Pediatric Gastroenterology, The Children's Hospital of Philadelphia, University of Pennsylvania
Vera De Matos, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

Medical Editor

Jayant Deodhar, MD, Associate Professor in Pediatrics, BJ Medical College, India; Honorary Consultant, Departments of Pediatrics and Neonatology, King Edward Memorial Hospital, India
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Stefano Guandalini, MD, Director, University of Chicago Celiac Disease Program, Section Chief of Gastroenterology, Hepatology and Nutrition; Professor, Department of Pediatrics, University of Chicago Comer Children's Hospital
Stefano Guandalini, MD is a member of the following medical societies: American Gastroenterological Association, European Society for Paediatric Gastroenterology, Hepatology & Nutrition, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

CME Editor

Steven M Schwarz, MD, FAAP, FACN, AGAF, Professor of Pediatrics, State University of New York, Downstate Medical Center College of Medicine; Distinguished Lecturer, New York Medical College, School of Public Health
Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research
Disclosure: TAP Pharmaceuticals Honoraria Speaking and teaching; Curemark, LLC Consulting fee Board membership

Chief Editor

Carmen Cuffari, MD, Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine
Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

 
 
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