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Diagnostic modalities for gastroesophageal reflux.
A K Patwari1, Pramila Bajaj, Ravi Kashyp
1Department of Pediatrics LHMC and Associated Kalawati Saran Children's Hospital, New Delhi, India. akpatwari@hotmail.com
Indian Journal of Pediatrics
|April 4, 2002
Summary
Diagnosing gastroesophageal reflux (GER) in children often requires multiple tests. Ambulatory 24-hour pH monitoring is the most effective single diagnostic tool for GER.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Clinical Diagnostics
Background:
- Gastroesophageal reflux (GER) is a common condition in infants and young children.
- Accurate diagnosis of GER is crucial for effective management and to prevent complications.
Purpose of the Study:
- To evaluate the effectiveness of commonly used diagnostic modalities for detecting GER in children.
- To compare the diagnostic yield of upper gastrointestinal endoscopy with esophageal biopsy (EB), gastroesophageal scintiscanning (GS), and 24-hour ambulatory pH monitoring.
Main Methods:
- Sixty children aged 1-72 months with suspected GER underwent upper gastrointestinal endoscopy with esophageal biopsy, gastroesophageal scintiscanning, and 24-hour ambulatory pH monitoring.
- Data from each diagnostic modality were analyzed and compared.
Main Results:
- GER was detected in 46.7% of cases by at least one modality.
- 24-hour ambulatory pH monitoring showed the highest detection rate (43.3%), followed by EB (38.3%) and GS (30%).
- When considered the gold standard, 24-hour pH monitoring demonstrated high sensitivity and specificity for EB and GS, with the reflux index (RI) showing the best performance among pH monitoring parameters.
Conclusions:
- A combination of diagnostic modalities may be necessary for accurate GER diagnosis in young children.
- Ambulatory 24-hour pH monitoring is the most effective single investigation for GER.
- Combining pH monitoring with EB and/or GS can maximize case detection.