A Very Young Barrett'S

INTRODUCTION: Barrett’s Esophagitis (BE) is defined by the presence of specialized intestinal metaplasia of the gastroesophageal junction. It is typically seen in persons with a chronic history of gastroesophageal reflux disease (GERD). We are presenting a case of an adolescent who was found to have BE with concomitant H pylori infection. Case Description/Methods: We have a 14-year-old otherwise healthy lady, who presented with worsening chronic abdominal pain associated with recent hematemesis and weight loss. She reports the pain was aggravated by food, without any alleviating factors. She had a normal CT abdomen a month prior to presentation. Three months ago she had an EGD at another facility, and was diagnosed with H. Pylori infection. She completed triple therapy with clarithromycin, followed by re- treatment due to persistent symptoms. A thorough laboratory workup was unrevealing including Total plasma porphyrins. An MR enterography was not suggestive of inflammatory or vascular etiology. Repeat EGD showed nodular gastritis with 1 cm salmon colored mucosa at GEJ, without fresh or old blood in the stomach. The distal esophageal specimen showed chronic inflammation with intestinal metaplasia with goblet cells, consistent with BE without dysplasia. The antral biopsy was consistent with severe chronic gastritis and positive for H pylori. The patient was discharged on quadruple therapy, i.e. tetracycline, metronidazole, omeprazole, and bismuth subsalicylate and a follow up with gastroenterology. DISCUSSION: BE is an important risk factor for esophageal adenocarcinoma. BE has an estimated prevalence of 5.6% in the United States and is most commonly seen in Caucasian men. This condition is typically diagnosed in people above the age of 50 years, who often have a history of chronic GERD. Other significant risk factors include central obesity, smoking and a significant family history. BE is exceedingly rare in younger populations and is usually seen in association with esophageal atresia. The findings of BE in our young patient without any of the known risk factors, raises questions regarding our current understanding of the natural history of this condition. Moreover, gastric biopsies were positive for H. pylori infection, which is, in fact, thought to be protective against BE. The risk of adenocarcinoma in patients with BE varies between 0.1–0.4% per year. With an increasing incidence of esophageal adenocarcinoma, there is a need to understand the lesser known variables implicated in the development of BE.