Clinical significance and natural history of esophageal histologic inflammation without macroscopic findings in children

Routine esophageal biopsies during pediatric esophagogastroduodenoscopy (EGD) are recommended by current guidelines, even in the absence of macroscopic abnormalities; however, their clinical value remains uncertain. We conducted a retrospective review of all diagnostic EGDs performed at our institute between January 2019 and December 2021, a period during which esophageal biopsies were routinely obtained. Endoscopic findings and histologic results were analyzed to determine the diagnostic yield and clinical impact of biopsies in patients with a normal-appearing esophagus. A total of 1400 procedures were included, of which 1279 (91.3%) demonstrated a normal macroscopic esophagus. Among these, histological inflammation was identified in 73 cases (5.7%). However, only 27 cases (2.1%) were considered clinically significant. These included eosinophilic esophagitis in 7 patients (0.5%) and nonspecific esophagitis in 20 patients (1.6%), all of whom were treated with proton pump inhibitors. The remaining cases represented histological findings without clinical consequences during follow-up. To conclude, routine esophageal biopsies in children and adolescents with a normal-appearing esophagus during EGD appear to have a low diagnostic yield and limited impact on clinical management.