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Gastroesophageal Reflux Burden, Even in Children That Aspirate, Does Not Increase Pediatric Hospitalization
Daniel R Duncan1, Janine Amirault, Nikki Johnston
1*Aerodigestive Center, Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, MA †Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee ‡Clinical Research Program, Boston Children's Hospital, MA §Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, MA.
Insights
Reflux burden in children does not predict hospitalization risk, even for those with aspiration risk. Routine reflux testing is not recommended as results do not impact clinical outcomes for pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Gastroesophageal Reflux Disease
- Clinical Outcomes Research
Background:
- Gastroesophageal reflux (GER) diagnosis and treatment remain controversial.
- The predictive value of reflux testing for clinical outcomes, especially in children with extraesophageal reflux complications, is poorly understood.
- Aspiration risk is a key consideration in managing pediatric GER.
Purpose of the Study:
- To determine if reflux burden impacts hospitalization rates in pediatric patients.
- To assess the relationship between reflux burden and hospitalization, adjusting for aspiration risk.
- To evaluate the clinical utility of reflux testing in predicting outcomes for children with suspected extraesophageal reflux.
Main Methods:
- Prospective cohort study of 116 pediatric patients with suspected extraesophageal reflux disease (2009-2014).
- Patients underwent multichannel intraluminal impedance with pH (pH-MII) and modified barium swallow studies.
- Hospitalization rates were tracked for at least 1 year post-testing; bronchoalveolar lavage with pepsin analysis was performed on a subset.
Main Results:
- No statistically significant relationship was found between reflux burden (measured by pH-MII or bronchoalveolar pepsin) and total admissions or admission nights, even after adjusting for aspiration status (P > 0.2).
- Reflux burden did not correlate with the number or duration of urgent pulmonary admissions, with or without adjustment for aspiration risk (P > 0.08).
Conclusions:
- Reflux burden does not increase hospitalization risk in pediatric patients, including those with aspiration risk.
- Routine reflux testing is not recommended for children with suspected extraesophageal reflux, as the results do not influence clinically significant outcomes.
Objectives:
Gastroesophageal reflux is common but remains a controversial disease to diagnose and treat and little is known about the role of reflux testing in predicting clinical outcomes, particularly in children at risk for extraesophageal reflux complications. The aim of this study was to determine if rates of hospitalization were affected by reflux burden even after adjusting for aspiration risk.
Methods:
We prospectively recruited, between 2009 and 2014, a cohort of pediatric patients with suspected extraesophageal reflux disease who were referred for reflux testing and underwent both multichannel intraluminal impedance with pH (pH-MII) and modified barium swallow studies. A subset of patients also underwent bronchoalveolar lavage with pepsin analysis. We determined their rates of hospitalization for a minimum of 1 year following pH-MII testing.
Results:
We prospectively enrolled 116 pediatric patients who presented for care at Boston Children's Hospital and underwent both pH-MII and modified barium swallow studies. There was no statistically significant relationship between reflux burden measured by pH-MII or bronchoalveolar pepsin and total number of admissions or number of admission nights even after adjusting for aspiration status (P > 0.2). There were no statistically significant relationships between reflux burden by any method and the number or nights of urgent pulmonary admissions before or after adjusting for aspiration risk (P > 0.08).
Conclusions:
Even in aspirating children, reflux burden did not increase the risk of hospitalization. Based on these results, routine reflux testing cannot be recommended even in aspirating children, because the results do not impact clinically significant outcomes.
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