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Gastro-oesophageal reflux: clinical profiles and outcome
W S Lee1, R M Beattie, N Meadows
1Department of Paediatrics, University of Malaya Medical Centre, Kuala Lumpur, Malaysia. LEEWS@medicine.med.um.edu.my
Insights
Gastro-oesophageal reflux (GOER) in children often presents with vomiting and feeding issues. Most infants experience an uncomplicated course, with up to 80% improving within a year of medical therapy.
Area of Science:
- Pediatric Gastroenterology
- Clinical Investigations
- Gastrointestinal Motility Disorders
Background:
- Gastro-oesophageal reflux (GOER) is a common condition in infants and children.
- Accurate diagnosis and management are crucial for optimal patient outcomes.
- Tertiary referral centers play a vital role in managing complex pediatric gastrointestinal cases.
Purpose of the Study:
- To evaluate the clinical characteristics of children with significant gastro-oesophageal reflux (GOER).
- To assess the diagnostic utility of various investigations in identifying GOER.
- To determine the treatment outcomes for children with GOER managed at a specialized center.
Main Methods:
- Retrospective study of 69 children diagnosed with significant GOER.
- Analysis of presenting symptoms, including vomiting, pain, feeding difficulties, and irritability.
- Review of investigations: 24-h lower oesophageal pH monitoring, barium studies, and upper gastrointestinal endoscopy.
Main Results:
- Recurrent vomiting (72%) and epigastric/abdominal pain (36%) were primary symptoms.
- pH monitoring revealed significant reflux in over 50% of cases.
- Endoscopy showed reflux oesophagitis in 62% and oesophageal ulceration in 6% of patients.
- Barium studies had a high false-negative rate for severe reflux.
Conclusions:
- Most pediatric GOER cases have an uncomplicated clinical course.
- Medical therapy is effective, with up to 80% of children showing improvement within 12 months.
- Nissen's fundoplication was required in a small percentage (6%) of refractory cases.
Objectives:
To assess the clinical features, investigations and outcome of 69 children (40 males, 29 females) with gastro-oesophageal reflux (GOER) referred to a tertiary referral centre in paediatric gastroenterology.
Methods:
A study of all patients with significant GOER seen at the Paediatric Gastroenterology Unit, Queen Elizabeth Hospital for Children, Hackney Road, London, between December 1994 and August 1995.
Results:
The median age at referral was 16 months. Presenting symptoms were recurrent vomiting (72%), epigastric and abdominal pain (36%), feeding difficulties (29%), failure to thrive (28%) and irritability (19%). Continuous 24-h lower oesophageal pH studies performed in 57 children showed 20 (35%) had a reflux index of between 10% to 20%, 14 (25%) had a index > 20%, and six (11%) had a postprandial reflux index > 10%. Reflux was shown in 38 (62%) of 62 children who underwent barium studies. None had significant anatomical abnormalities, but in the 22 children who had a negative barium studies, six had severe reflux (reflux index > 20%). Upper gastrointestinal endoscopy performed in 47 children showed reflux oesophagitis in 29 (62%), oesophageal ulceration in three, and Barrett's oesophagus in one. All of the children were treated with standard medical therapy. Sixty-six per cent were able to discontinue medication within 12 months and remained well. Four children (6%) required Nissen's fundoplication for failure to respond to medical therapy.
Conclusions:
Most infants with GOER have an uncomplicated course. False negative results were noted in both pH monitoring and barium meal. Up to 80% of children, with therapy, will improve within 12 months.