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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
Insights
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.
Objective:
To evaluate commonly utilized diagnostic modalities to detecting Gastroesophageal Reflux (GER).
Methods:
Sixty children aged 1-72 months (mean age 14.7 months) with symptoms suggestive of Gastroesosphageal Reflux (GER) were investigated and subjected to upper gastrointestinal endoscopy and esophageal biopsy (EB), gastroesophageal scintiscanning (GS) and 24 hour ambulatory pH monitoring.
Result:
GER was detected in 28 (46.7%) cases by one or more diagnostic modalities. Ambulatory 24 hour pH monitoring was positive in higher proportion (43.3%) of cases in comparison to other modalities, followed by EB (38.3%) and GS (30%). Considering 24 hour pH monitoring as the gold standard, esophageal biopsy was positive in 22/26 cases (84.6%) detected by 24 hour pH monitoring with a specificity of 97.1% as compared to 17/26 cases (65.4%) by gastroesophageal scintiscanning with a specificity of 97.1%. When compared with EB results, amongst various parameters measured during 24 hour pH monitoring, Reflux index (RI) ranked highest (sensitivity 95.6 % and specificity 89.2 %) followed by duration of longest episode > 20 minutes and Euler Byrne score. Oscillatory index, calculated from tracings of pH monitoring, even though ranked lower because of its low sensitivity helped to pick up 2 cases missed by EB and RI.
Conclusion:
Our results suggest that a combination of diagnostic modalities may be required to diagnose GER in young children. Ambulatory 24 hour pH monitoring appears to be the single best investigation and combining it with EB and/or GS can help to detect maximum number of cases.