Barrett's Esophagus in teen agers.

[Arty__0__0]

  My 15 yr.old son just diagnosed with Barrett's esophagus. Has undergone endoscopy and biopsy and is currently taking 20 mg prilosec 2x a day.  Am trying to locate info on this problem in children, treatments, recommendations for frequency of follow endoscopy's etc.  Dr. is planning a PH study after 6-8 weeks on meds. to determine if helpful. If acid levels are reduced what are possiblities of this turning malignant.  any info will be helpful because Dr. is unfamiliar with this problem in teenagers.
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Dear Arty,
I hope that the following information regarding Barrett’s esophagus in children will be helpful to you.  First, the diagnosis of Barrett’s esophagus can be difficult to make in children.  Careful endoscopy with multiple biopsies are necessary to confirm the diagnosis.  The pathologist should see specialized mucosa with goblet cells. Second, the number of cases of malignancy in children with Barrett’s esophagus is low.  Of these cases most had the cancer at the time the Barrett’s was diagnosed.  Third, there are no scientific criteria to direct the frequency of screening and most approaches rely on anecdotal data.  One author recommended the following approach:
a) endoscopic surveillance is suggested only for patients who have specialized intestinal changes.
b) treatment with potent acid suppressors ( as are being used for your son) should be tried for 3 months.  Healing of the inflammation will reduce the chance that cellular changes associated with inflammation are being  confused with premalignant changes.
c) endoscopic surveillance should be performed every 2-3 years although each case must be evaluated separately.  There are a number of requirements regarding the locations of esophageal biopsies that are familiar to your physician.
Finally, there has not been well documented cases that either medical or surgical treatment causes complete regression of Barrett’s esopahgus and the return of normal lining.
I hope that this information will answer some of your questions.  Best of luck.
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician. If you wish to be seen at our institution, Henry Ford Hospital, please call our PHYSICIAN REFERRAL LINE at(313) 876-2393 and request consultation with Dr. William belknap, our pediatric gastroenterologist.
HFHSM.D.-rf
*keywords: barrett’s esophagus, esophagitis, children
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