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Editor,—I read with interest the article by Van der Burgh et al (Gut 1996; 39: 5–8). I am surprised that the authors did not mention the paper by Hassallet al,1 who collected nine cases of adenocarcinoma in patients between 11 and 25 years of age. Hassallet al conlude that adenocarcinoma does occur in patients under 25 years of age as a complication of Barrett’s oesophagus arising in childhood. They advocate endoscopic surveillance with multiple stepwise biopsies beginning at 10 years of age in children with Barrett’s oesophagus with specialised mucosa and goblet cells.
We have published two cases2 of adenocarcinoma in childhood developing in Barrett’s oesophagus. The first case was an 11 year old boy admitted to hospital for dysphagia caused by a foreign body in the oesophagus. An oesophageal adenocarcinoma arising in Barrett’s oesophagus was diagnosed. The second case was a 14 year old boy who had peptic oesophagitis with ulceration; 11 months later an adenocarcinoma of the oesophagus was diagnosed. Adenocarcinoma arising in Barrett’s oesophagus has been recognised in young adults and starts earlier in life than the usual squamous cell carcinoma, but in our review of the literature we found very few examples of oesophageal cancer in children. We emphasise the need for long term follow up of such children with a history of oesophageal abnormalities, even after treatment of reflux, because the peptic oesophagitis scar remains, particularly when peptic stenosis has been treated with dilatation and antireflux surgery.