Peptic esophageal stricture in children.

INTRODUCTION: Peptic esophageal stricture as a complication of gastroesophageal reflux disease (GERD) occurs in 5% of the affected children. MATERIAL AND METHODS: Case histories of 6 children treated successfully in the Department of Pediatrics and Clinic of Pediatric Surgery were studied. The diagnosis in each case was based on clinical symptoms (vomiting leading to hypothrophy, hematemesis, and anemia), and esophagoscopy, esophageal pH-metry (according to ESPGAN recommendations), and contrast X-ray examination. After evaluation medical treatment was applied in 3 and bougienage with a hard bougie in 6 patients. Because of failure of this treatment Nissen fundoplication and postoperative bougienage were performed in all patients. RESULTS: In all surgically treated patients complete recovery without postoperative complications was achieved. DISCUSSION: The authors give interpretation of the pathogenesis and outline the primary symptoms of the disease. Terms of performance and reliability of the instrumental methods of diagnosing are discussed. The experience in treatment of peptic esophageal stricture in children is presented. CONCLUSIONS: Medical treatment combined with bougienage yields poor results in peptic esophageal stricture and Nissen fundoplication appears to be the treatment of choice.

Degenerative vascular changes in children with diabetes mellitus.

Twenty three diabetic children aged 4 to 16 years with duration of the disease from 2 months to 10 years were investigated for microvascular complications. Eight of them (34.8%) had kidney disorders (low creatinine clearance, fluctuating microproteinuria, echographic changes), and nine children (39.1%) had peripheral neuropathy (sensory disorders as assessed by electromyography). Seven children (30.4%) were found to have microscopic alterations of the capillary loops of the nail wall. Ophthalmopathy was found in two (8.7%). There was no correlation between the microvascular complications and the age of children. The duration of the disease affected the severity of the complications. Microangiopathy was related to the degree of compensation of diabetes. It is emphasized in conclusion that the degenerative vascular complications have their onset rather early in childhood diabetes. They can be detected simultaneously with the diagnosis of diabetes, and therefore should be sought, duly diagnosed and treated.