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[Acidic stimulation of esophageal peristalsis: its prognostic value in reflux]
1Universidad del País Vasco, Hospital Materno-Infantil Nuestra Señora de Aránzazu, Servicio de Cirugía Pediátrica, San Sebastián.
Insights
An esophageal acid challenge test can predict if children with gastroesophageal reflux (GER) will need surgery. This test measures esophageal motor efficiency, distinguishing between children who respond to medical treatment and those who do not.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Motility Disorders
Background:
- Gastroesophageal reflux (GER) in children presents diverse clinical symptoms, complicating diagnosis and surgical decision-making.
- Previous research indicates GER is associated with impaired esophageal peristalsis.
Purpose of the Study:
- To evaluate the prognostic value of an esophageal acid challenge test in predicting the need for surgery in pediatric GER.
- To assess if esophageal motor efficiency (EME) after acid challenge differentiates treatment responders from non-responders.
Main Methods:
- Esophageal Motor Efficiency (EME) was measured in 52 children with GER under basal conditions and after esophageal acid instillation.
- Children were categorized into two groups based on their response to medical treatment for over six months.
- EME parameters, including sensitivity and specificity, were analyzed to determine prognostic value.
Main Results:
- Basal EME did not differentiate between the groups.
- EME after acid challenge significantly distinguished between children who responded to medical treatment and those who did not.
- An optimal threshold value of 565 for post-acid challenge EME demonstrated a sensitivity of 0.76 and specificity of 0.75.
Conclusions:
- The esophageal acid challenge test shows prognostic value in identifying children with GER who may require surgical intervention.
- This test aids in predicting treatment outcomes and guiding clinical management decisions for pediatric GER.
Abstract:
Gastroesophageal Reflux (GER) in children manifests itself by several clinical pictures. Its diagnosis is difficult and so are surgical indications. The search for prognostic parameters able to predict the need for surgery are therefore warranted. We have demonstrated in previous studies in children with GER a decrease in propulsive peristalsis and an increase in non-propulsive activity. We have also reported that patients able to respond to medical treatment correct their motor trouble when acid is instilled into the esophagus, whereas those unable to respond to it do not. Aiming at clarifying the prognostic value of this acid challenge test we have thus measured Esophageal Motor Efficiency (EME) (prop. waves/h multiplied by mean pressure) in basal conditions and after acid challenge in 52 children divided into two groups according to their response to medical treatment during periods exceeding 6 months. EME in basal conditions did not allow differentiation between both groups, but EME after acid challenge did so. Optimum threshold value was 565, sensitivity 0.76, specificity 0.75, positive predictive value 87%, and negative predictive value 60%. This test seems to have some prognostic value in pediatric GER.