Barrett's in children

Barrett's in children does occur, but is rare. This cases series demonstrates a very strong preponderance in males. Among a very few children followed over time, several developed low grade dysplasia, but non were observed to progress to high grade dysplasia or cancer.

Dig Dis Sci. 2020 Jul 18.
doi: 10.1007/s10620-020-06462-5. Online ahead of print.

Esophageal Columnar Metaplasia in Childhood: A Population-Based Case Series Analysis

Leah Twohig-Bennett 1 , Helen G Coleman 1 , Victoria Cairnduff 1 , Damian T McManus 2 , Liam J Murray 1 , Anna T Gavin 1 3 , Brian T Johnston 4

PMID: 32683588 DOI: 10.1007/s10620-020-06462-5

Abstract

Background: Adults with Barrett's esophagus (BE) are often entered into surveillance for esophageal adenocarcinoma (EAC), although cancer risk is relatively low. BE can be detected in children (< 16 years). Little is known about the epidemiology of pediatric BE, and it is unclear what the optimal surveillance regimes are in children.

Aim: To evaluate the demographic and clinical characteristics, and future neoplastic progression risk in all pediatric BE patients diagnosed in Northern Ireland between 1993 and 2010.

Methods: Data from the population-based Northern Ireland BE register were matched to the Northern Ireland Cancer Registry for EAC outcomes until end 2013. Age-adjusted incidence of pediatric BE was calculated, and characteristics between pediatric and adult BE patients compared using Chi-square tests.

Results: Over 18 years, 42 pediatric BE patients (< 16 years) were identified, equivalent to an age-adjusted incidence of < 2 per 100,000 children. There was a clear age differential, with BE incidence increasing with age within the pediatric population. The majority (85.7%) of patients were male, a significantly higher male/female ratio than adult BE patients (p < 0.001). No pediatric BE patients progressed to high-grade dysplasia (HGD) or EAC, although the eldest patient was aged 34 years by the end of follow-up.

Conclusions: This is the largest series of pediatric BE ever reported. It demonstrates that pediatric BE is rare. The male preponderance of this condition is more apparent in childhood compared with adult cases. No children developed HGD/EAC during follow-up, suggesting that regular surveillance is not required, at least until adulthood.

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