Heterogeneity of metaplastic changes in the esophagus: differential diagnostic and therapeutic approaches
The investigation was aimed at studying a clinical course and pathogenetic mechanisms of the formation of metaplastic changes in the esophageal mucosa and at working out recommendations on diagnosing and choosing a treatment. The observation involved 109 children, in whom erosions in the esophagus and metaplastic changes of the esophageal epithelium were detected. In the majority of bioptates a histological examination revealed changes of the mucosa characteristic of gastroesophageal reflux disease and chronic esophagitis. In 78% of cases the structure of the epithelial mucosa corresponded to the mucosa of the cardial portion of the stomach. In 26 observations, small foci of small intestinal metaplasia were found in bioptates, apart from inflammation. In 24 cases metaplastic gastric-like changes of the lower third of the esophagus were seen. Conservative therapy was given to 55 children with erosions, to 23 children with gastric metaplasia, and to 18 patients with intestinal metaplasia. Besides, electrocoagulation was performed in 14 patients, laser photovaporization in 2 patients, the Nissen operation in 20 children, the Nissen operation in combination with electrocoagulation in 2 children. An analysis of the results of the examination and treatment demonstrated that in children with intestinal metaplasia of the epithelium of the esophagus endoscopic electrocoagulation of metaplastic sites might be recommended, which can be added by either conservative treatment or Nissen gastrofundoplication. Based on the experience, the authors formulated an algorithm of a differentiated choice of treatment for children with metaplastic changes in the esophagus.