The major cause of esophagitis in infants is reflux of acid contents from the stomach into the esophagus. In adults up to 90% of refluxed material in the esophagus is cleared within seconds and the rest neutralised by swallowing of saliva. This is not the case in infants.

It is also suggested that pepsin in the presence of acid may be the corrosive factor. Pepsin is most active in pH below 2. Studies have shown that infants as young as 24 weeks gestation can produce acid levels below pH2 in the stomach.

Esophagitis following reflux is a chemical corrosion of the esophagus. Other chemical corrosion leading to damage of the esophageal lining can be from ingestion of garden or household substances. This caustic injury has increased of late and mainly due to accidental ingestion.

Compounds ingested includes bleach, dishwater solvents and detergent. Children growing up in farms could accidentally ingest industrial chemicals. Drugs that are associated with damage to the esophagus are tetracycline ( no longer given to under 12s), acne products and non-steroidal anti-inflammatory drugs (NSAID).

A child, after ingesting corrosive chemicals, will complain almost immediately. The child will cry, spit or cough. The child will be frightened.

In a study of 378 children with corrosive ingestion, 82% of symptomatic cases had minor damage to the esophagus and 12% that had no symptoms had severe esophageal damage.

All children with suspected ingestion of corrosive substance should be admitted to hospital.

Of the children that develop strictures following ingestion of caustic chemicals, 50% will be in the first month, 80% in the first 2 months and all within 8 months.

Other causes of esophagitis will be discussed in subsequent posts.

Dr. Phil Hariram,