Esophageal achalasia is a neuromuscular disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and the absence of normal peristalsis in the esophageal body. In the pediatric population, the disease occurs with an incidence of 0.1-0.18 cases per 100,000 children. The “gold standard” of diagnostics is high-resolution manometry (HRM). It not only confirms the diagnosis but also determines the manometric type of achalasia according to the Chicago Classification (version 4.0), which is very important for selecting the correct myotomy length. Traditional treatment methods were balloon dilation (BD) and laparoscopic Heller myotomy (LHM). However, BD is associated with a high risk of recurrence and the need for repeated interventions, while LHM, despite high efficacy (up to 85%), is not without the risk of intraoperative complications and is completely ineffective for the spastic (type III) type. Between 2017 and 2024, 21 surgical interventions were performed in 21 children with achalasia (mean age 14.3 years). The diagnosis was confirmed based on upper endoscopy, timed barium esophagogram and high-resolution manometry (performed in 14 patients, 70%). Distribution by manometric type: Type I - 2 patients (10%), Type II - 10 patients (50%), Type III - 2 patients (10%). The mean pre-operative Eckardt symptom score was 6.58. All procedures were successfully completed without intraoperative complications or conversion. Clinical efficacy (reduction in Eckardt score to ≤ 3) at 3 and 12 months of follow-up was 100%. Endoscopic signs of GERD at 3 and 12 months after treatment were observed in 10 (47,6%) and 8 (38%) children, respectively, while symptomatic reflux bothered only 5 patients (23%). Thus, POEM demonstrated high clinical efficacy (100%) and safety in the treatment of esophageal achalasia in children. The incidence of postoperative reflux esophagitis remains a subject for further study and requires long-term follow-up.

Relevance. Intestinal lymphangiectasia is a very rare condition that causes damage to the lymphatic capillaries of the small intestine. This condition is associated with the development of lymphopenia. The purpose of this study is to provide up-to-date information on the etiology, pathogenesis, diagnosis, and treatment of patients with intestinal lymphangiectasia. The main part. There are primary and secondary lymphangiectasia. Primary lymphangiectasia is congenital and is most likely genetically determined. It is characterized by morphological failure of the lymphatic capillary wall, which manifests itself in the absence of valves, endothelial defects, and weakness of the connective tissue framework. This leads to overstretching and increased permeability of the lymphatic vessels, even when the lymphatic pressure is normal. Secondary develops against the background of a disease that leads to obstruction of the lymphatic vessels, which leads to an increase in lymphatic pressure. The consequence of lymphopenia is the formation of the syndrome of exudative enteropathy. Loss of plasma proteins leads to hypoalbuminemia, a decrease in plasma oncotic pressure and hypoproteinemic edema. Loss of lymphocytes turns into lymphopenia and secondary immunodeficiency. Loss of fats and vitamins leads to steatorrhea, hypocholesterolemia, deficiency. Conclusion. The key step in the treatment of intestinal lymphangiectasia is diet and symptomatic therapy. In the case of secondary lymphangiectasia, the priority is to eliminate the underlying cause of lymphostasis.

Introduction: Dystrophic epidermolysis bullosa (DEB), one of the most severe forms of congenital epidermolysis bullosa, is characterized by the development of multiple surgical complications, including esophageal stenosis/stricture. Fluoroscopy-guided balloon dilation (BD) is the main therapeutic approach; however conservative treatment is required to prevent recurrence. Losartan has been proposed as a promising option because of its antifibrotic effects, potentially mediated by suppression of transforming growth factor β1 (TGF-β1) signaling. Purpose: To evaluate the effectiveness of losartan for preventing restenosis after esophageal BD in children with DEB. Materials and Methods: The study included 19 children with DEB (age 2-16 years; mean age 9.2 ± 3.58 years), 6 boys (31.6%) and 13 girls (68.4%), with X-ray confirmed esophageal stenosis. All patients underwent esophageal BD. In the treatment group (n=9), children received losartan and standard topical therapy; in the control group (n=10), only standard therapy was administered. The observation period was 12 months. Outcomes included the rate of esophageal restenosis, nutritional compromise (THINC tool), and disease severity assessed (EBDASI index). Results: Repeat dilation was required in 1 child (11.1%) in the treatment group and in 4 children (40.0%) in the control group. Nutritional compromise scores and disease severity (EBDASI) were also significantly lower in the group of children treated with losartan. No adverse drug reactions were observed. Conclusions: In this study, losartan demonstrated its safety, was associated with a lower rate of esophageal restenosis, and improved nutritional status in children with DEB after BD. Further studies are required to confirm its efficacy.

Crohn’s disease (CD) is a multifactorial inflammatory disease in which any part of the gastrointestinal tract can be affected, however, it usually affects the ileum and/or colon. In order to assess the prognosis of the patient and the selection of an appropriate therapy regimen, it is necessary to accurately assess the factors affecting negative results, including the disease phenotype. Recently, with the introduction of mandatory endoscopic examination of the upper gastrointestinal tract (UGI) with suspected Crohn’s disease, diagnosis of organ lesions of this localization has become more common and described in the literature. Most of the clinical manifestations of esophageal, gastric or duodenal lesions are nonspecific and require morphological verification of the diagnosis, since they can occur under the guise of ordinary gastritis or duodenitis. In addition, histological findings such as marked focal erythematous gastropathy and non-vascular granulomas may be suggestive of CD. The association between upper UGI involvement and poor prognosis in Crohn’s disease remains controversial. Currently, there are no criteria for assessing the severity of the lesion and understanding the degree of participation of the upper gastrointestinal tract in CD for the long-term prognosis of the disease. This article presents the children’s own examination data and a clinical case of gastric and duodenal involvement at the onset of Crohn’s disease.

Anemia is one of the most common pediatric diseases, caused by various factors of both endogenic and exogenic origin. Modern diagnostic tools, including endoscopy, make it possible to identify the very etiology within a short period of time. However there still exists a certain category of patients with prolonged diagnostic process associated with elevated risk of severe complications. Those are children with some abnormalities of psycho-emotional development, having difficulties in communication and, at the same time, non-specific clinical picture. Such patients are usually treated conservatively for a long time without any endoscopic diagnostics because of insufficient surgical vigilance at the outpatient stage. Herein we demonstrate several clinical cases in which endoscopy had served not just as basic diagnostic method, but also as a therapeutic one. Analysis of such cases suggests necessity of active and timely use of endoscopy in pediatric practice concerning treatment of anemia in patients with specific neurologic status.

This publication presents a rare, previously unreported clinical case of comorbidity between the orphan disease lysosomal acid lipase deficiency (LALD) and eosinophilic esophagitis (EoE). LALD is a progressive systemic disease that leads to lipid accumulation in organs and tissues, primarily affecting the liver and cardiovascular system. EoE is a chronic immune-mediated disease of the esophagus, characterized by severe eosinophilic inflammation of the esophageal mucosa and symptoms of esophageal dysfunction, often associated with various comorbid allergic diseases. Based on international publications, an analysis of changes detected during EGDS in patients with LALD is conducted. This case report demonstrates the value of EGDS in children with this disease. The endoscopic and morphological changes detected are highlighted. Current treatment options for LALD and EoE in children are described.

Objective. To evaluate the efficacy and safety of retrograde (gastrostomy-assisted) balloon dilation (BD) for esophageal strictures in children with dystrophic epidermolysis bullosa (DEB). Materials and Methods. Single-center retrospective case series (2016-2025): eight children with DEB and grade II-IV dysphagia underwent retrograde BD via a mature gastrostomy under combined endoscopic and fluoroscopic guidance; preoperative work-up included a water-soluble contrast esophagogram. Balloons 10-15 mm in diameter (length 55 mm) were used; anesthesia was inhalational mask anesthesia with spontaneous ventilation. Outcomes included stricture location/length, luminal diameter, change in Bown dysphagia score, adverse events, recurrences, and remission duration. Results. Strictures were predominantly located in the upper third of the esophagus (6/8); two patients had two strictures (upper/mid-third). Mean luminal diameter at dilatation was 4 ± 1.6 mm; clinical success was achieved in 100% of patients. The Bown score improved from 2.7 ± 0.7 to 0.4 ± 0.5. No major complications occurred (only moderate odynophagia for 3-5 days). Over two years of follow-up, all patients experienced recurrences requiring repeat retrograde dilations; remission duration was 6-18 months. Conclusion. Retrograde BD in children with DEB demonstrates high efficacy and a favorable safety profile while avoiding oropharyngeal trauma. The technique is appropriate in the presence of a gastrostomy; larger prospective studies are needed for head-to-head comparison with antegrade BD.