Esophagus and Stomach Disorders
Scope
This domain covers GERD, eosinophilic esophagitis, achalasia, gastritis, peptic ulcer disease, H. pylori, and gastric motility disorders.
Key concepts
- GERD vs physiologic reflux: regurgitation is common in infants and resolves; alarm signs (poor growth, hematemesis, apnea, dysphagia) suggest pathologic GERD.
- Eosinophilic esophagitis (EoE): dysphagia, food impaction, atopy; diagnosis requires esophageal eosinophils (≥15/hpf) on biopsy; treat with PPI, topical steroids, or elimination diet.
- H. pylori: test-and-treat with urea breath test or stool antigen; endoscopy with biopsy for diagnosis; avoid in asymptomatic children.
- Peptic ulcer disease: duodenal ulcers often H. pylori-related; gastric ulcers warrant biopsy to exclude malignancy in adults, but in children consider NSAIDs and stress.
- Achalasia: progressive dysphagia to solids and liquids, bird-beak on barium swallow, manometry confirms.
Traps
Questions conflate EoE with GERD-both cause eosinophils, but EoE persists despite acid suppression. Another trap: treating H. pylori empirically without testing. Beware attributing infant irritability solely to reflux without evaluating feeding and growth.
Worked example
A 10-year-old with dysphagia, food impaction, and atopy: suspect EoE. Endoscopy with biopsies showing ≥15 eosinophils/hpf confirms; trial of PPI first or topical swallowed steroids.
Rule of thumb
Dysphagia in a child with atopy = think EoE; dysphagia to solids and liquids with bird-beak = achalasia.