Objectives and Study

Fungal oesophagitis is the predominant cause of oesophageal infection and its prevalence in immunocompetent adults is rising. However, there is minimal data on the clinical features and predictive factors of fungal oesophagitis in children without human immunodeficiency virus (HIV) infection. Therefore, the objective of this study was to determine the prevalence, symptoms, endoscopic appearances and predictive factors of fungal oesophagitis in children, regardless of immune status.

Methods

A 2010-2020 retrospective case-control study was conducted on 1823 children presenting to Sydney Children’s Hospital for elective endoscopy with oesophageal biopsy. Histopathology reports were reviewed to identify fungal oesophagitis cases and determine prevalence rates. 32 patients with fungal oesophagitis were age- and sex-matched (1:2) to 64 controls, and Chi-squared and Fischer’s exact tests were conducted to ascertain clinical manifestations and potential predictive factors associated with fungal oesophagitis. Risk factors were subsequently identified via multivariate logistic regression analysis.

Results

The prevalence of fungal oesophagitis in children was 1.76%. Common symptoms included dysphagia (25%), heartburn (25%), poor oral intake (21.9%), vomiting (18.8%), cough (15.6%), nausea (12.5%) and weight loss (9.4%). No significant symptomatic differences were found between cases and controls. On endoscopy, white plaques were significantly associated with fungal oesophagitis (cases=59.4% vs controls=4.7%, p<0.001), though normal endoscopies were reported in 28.1% of cases. Topical swallowed corticosteroids were a significant independent risk factor for fungal oesophagitis (aOR=10.740, 95% CI: 1.213-95.101, p=0.033), whilst eosinophilic oesophagitis (aOR=0.493, 95% CI: 0.069-3.522, p=0.481), oesophageal atresia/tracheo-oesophageal fistula (aOR=3.214, 95% CI: 0.613-16.844, p=0.167) and proton pump inhibitors (aOR=1.829, 95% CI: 0.625-5.355, p=0.271) were not.

Conclusions

The prevalence of fungal oesophagitis in this pediatric cohort reflects rates in immunocompetent adults. Given that children often presented with non-specific symptoms and endoscopic appearances, oesophageal biopsy is required for an accurate diagnosis. Clinicians should consider the risk of fungal oesophagitis when prescribing topical swallowed corticosteroids.

Objectives and Study

Spinal Muscular Atrophy (SMA) is not only a neuromuscular disease but also a multi-systemic disorder suspected in recent animal studies to be associated with T-cell maturation dysfunction and neuro-inflammation. We aimed to investigate the prevalence of another inflammatory disorder, eosinophilic esophagitis (EoE) in patients with SMA.

Methods

Patients with spinal muscular atrophy who investigated with endoscopy between 2018-2022 for any reason were included in this study at the Department of Paediatric Gastroenterology, Hepatology and Nutrition in Istanbul Medipol University. All pathology samples of patients were evaluated by the same pathologist. Fifteen eosinophils in mid-esophagus per high-power field were considered a minimum threshold for a diagnosis of EoE.

Results

A total 58 endoscopic procedures in 32 (18 girls) patients with SMA were evaluated retrospectively. The most common symptoms were vomiting (15/32), retarded growth (9/32) and hematemesis (7/32). EoE was diagnosed histopathologically in 25% of the patients (8/32) at the first endoscopy. The mean duration between first and second endoscopic procedure time were 6 (4-10) months. There were 27 patients using proton pump inhibitor, 17 of them were on aminoasit formula started empirically based on their symptoms and endoscopy results and 3 of them received topical budesonide after diagnosis. The rate of eosinophils in blood count was over 5% in 24 patients. There were 3 patients with milk, 2 patients with egg white and 1 patient with egg yolk specific IgE positivity. Median Total IgE were 17.9 (5.7-89.8).

Conclusions

SMA is a very rare neuroinflammatory multi-systemic disease. Prevalence of EoE among these patients was about 700 times more than normal population according to this study. EoE should be considered in every SMA patient. This coexistence may be a new window into understanding the unexplained pathogenesis of this two rare diseases.

Objectives and Study

Feeding difficulty, recurrent respiratory problems highly require a coordinated aerodigestive complex approachment. The main recommendation about complex aerodigestive diseases is that, esophagogastroduodenoscopy (EGD), flexible bronchoscopy and otolaryngological examinations should be done concomitantly by separate collocated specialist in an integrated practice unit (IPU), is a crucial when it is necessary.

Methods

Hereby, consecutive 15 patients from January 2018 to December 2022 who underwent concomitantly triple endoscopic examination by Pediatric Aerodigestive Team in IPU. Electronic patient records were collected, retrospectively.

Results

Of 15 (n=10 male), the median age on admission was 19,23(2,03-158) months. The median triple examination time was 2,4 (0,1-42) months after admission. The primer admission diagnoses were recurrent airway infections (n:4), hypotonic infants with swallowing dysfunction(n:3), other neurologic problems (n:4), operated esophageal atresia with tracheoesophageal fistula (n:3) mostly. Esophagitis was the most common finding on EGD (9/15), and , EGD with biopsies 5/15(33,3%) were normal without histologic abnormalities. Tracheomalacia was the most common finding on flexible bronchoscopy (7/15) . Eight patients had positive bronchoalveolar lavage culture positivity and none of them were either ARB positive or mycobacterium PCR positive. Otolaryngological examination showed n=1 adenoid hypertrophy, n=1 septal deviation. Video fluoroscopic swallow study (VFSS) was evaluated for 6 patients and half of them was abnormal.

Upper gastrointestinal imagining were performed in 7 patients by a separate time. Four patients showed GERD and other findings were as n=1 vascular compression, n=1 dysmotility of esophagus with atonic stomach, n=1 tertiary motility on esophagus

After all evaluations, n=6/15 received anti-reflux medical therapy, n=2/15 had antibiotics, n=2/15 were placed percutaneous endoscopic gastrostomy, n=2/15 had eosinophilic esophagitis treatment, one patient was referred to pediatric surgery for tracheal fistulae.

Conclusions

Aerodigestive diseases need multisystemic manifestations. Triple examination may save time for definite diagnosis and makes less sedo-analgesia exposure.

Objectives and Study

Approximately 1 in every 4100 people worldwide are born with oesophageal atresia +/- tracheo-oesophageal fistula (OA/TOF). Whilst surgical correction is, in most cases, performed within the early years, physiological dysfunction remains. The care of this group of people is disparate with no clear guidance outside of surgical management. This qualitative study embedded within the ocelot study (https://tofs.org.uk/ocelot-study/), which seeks to determine a core outcome set for this patient population, explored the experiences of adults and children of living with OA/TOF.

Methods

Five focus groups and five individual interviews were conducted via video-conferencing software. The groups were facilitated by clinicians, researchers and Tracheo-Oesophageal Fistula Support (TOFS) charity leads. Participants were invited through TOFS charity and included individuals born with OA/TOF, or a parent of a person born with OA/TOF. A topic guide shaped the focus group discussion, but the group conversation was open and free. Data were transcribed, coded and themes identified.

Results

Participants included 12 adults and 4 children with OA/TOF and 6 family members. Despite varying ages and backgrounds, similar themes were common throughout.

The participants, regardless of age continued to face daily challenges. They reported a misconception, particularly from general health care services, that they had been ‘fixed at birth’ and therefore no longer should experience symptoms related to their OA/TOF. Participants’ lives were disrupted by having to make alterations to their life to allow for eating difficulties.

Conclusions

The level of ongoing disruption to life experienced by these participants was surprising to the clinicians on the team. There are indications that routine follow up beyond the paediatric years and altering the medical terminology, which implies someone has been fixed, may help to recognise the ongoing nature of the symptoms associated with this anatomical abnormality. Further work is required to develop an agreed lifelong standard of care for this group of patients.