Barrett's metaplasia complicating gastro-oesophageal reflux disease in a 3-year-old child: A case report

Abstract

Introduction

Gastro-oesophageal reflux disease (GORD) can cause significant complications in children. Barrett's oesophagus (BO) is an uncommon and late-presenting complication that is rare in children but has significant life-long implications.

Case presentation

A 3-year-old boy presented with faltering growth, weight loss, and episodes of haematochezia and melaena. His past medical history included primary gastrostomy at 10 months for incoordinate swallowing, and gastro-oesophageal reflux disease managed with omeprazole (1mg/kg once daily). On admission, his haemoglobin was 85 g/L. Oesophagogastroduodenoscopy (OGD) revealed severe oesophagitis with a tight, impassable stricture 15 cm from the incisors. Contrast swallow confirmed the stricture and biopsy showed mild spongiosis above it. Four weeks later, a single balloon dilation was performed using a CRE PRO™ Balloon Dilatation Catheter, dilating the stricture to 8 mm. A nasojejunal (NJ) tube was inserted due to his emaciated state. Biopsy of the distal oesophagus showed metaplasia consistent with BO. Post dilation, he was admitted for a two-week period of NJ tube feeding, after which he underwent laparoscopic Nissen fundoplication with hiatal hernia repair and new Stamm gastrostomy. Postoperatively, he transitioned to gastrostomy feeding and following a transient dumping syndrome he gained significant weight. At 6-month follow-up, repeat OGD and biopsy showed resolution of his stenosis and metaplasia. The patient was tolerating bolus feeding through his gastrostomy, with continued weight improvement. At his 18-month review, he remained well and was scheduled for ongoing endoscopic surveillance.

Conclusion

Gastro-oesophageal reflux disease, even when managed with anti-acid medication, can lead to Barrett's oesophagus in children as young as 3 years of age.