Paediatrics: Congenital abnormalities: oesophagus

Congenital abnormalities: oesophagus

Oesophageal stricture

Oesophageal strictures in children may be congenital (5%) or acquired (95%). Strictures may be acquired as a result of reflux oesophagitis, caustic ingestion, or following repair of OA. Congenital oesophageal strictures most commonly affect the middle and distal third of the oesophagus and rarely cause symptoms in the neonatal period. They may be due to:

•   membranous diaphragm;

•   segmental submucosal fibrosis;

•   presence of ectopic tracheobronchial rests.

Presentation

Strictures present with:

•   regurgitation of undigested food;

•   bolus obstruction;

•   failure to thrive.

Diagnosis

•   Barium swallow.

•   Oesophagoscopy.

Treatment.

•   Peptic strictures are an absolute indication for anti-reflux surgery.

•   Congenital strictures may respond to dilatation but resection or oesophageal replacement is often necessary.

Caustic ingestion

•   Acute phase: resuscitate and support with IV fluids and antibiotics.

•   Endoscopy: to confirm the severity of the burn.

•   Feeding gastrostomy: in severe strictures.

Chronic phase: serial oesophageal dilatation is performed, but many children require oesophageal replacement.