Related Experiment Video
Updated: Feb 26, 2026
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
The Prevalence of Rome IV Nonerosive Esophageal Phenotypes in Children
Lisa B Mahoney1, Samuel Nurko1, Rachel Rosen1
1Aerodigestive and Motility and Functional Gastrointestinal Disorders Centers, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA.
Insights
Functional heartburn is the most common Rome IV nonerosive esophageal phenotype in children. Microscopic esophagitis and proton pump inhibitor (PPI) responsiveness do not predict these pediatric phenotypes.
Area of Science:
- Pediatric Gastroenterology
- Esophageal Physiology
- Gastrointestinal Motility Disorders
Background:
- Nonerosive esophageal phenotypes are increasingly recognized in pediatric gastroesophageal reflux disease (GERD).
- Accurate classification of these phenotypes is crucial for effective management.
- Rome IV criteria provide a framework for diagnosing functional gastrointestinal disorders, including nonerosive esophageal conditions.
Purpose of the Study:
- To determine the prevalence of Rome IV nonerosive esophageal phenotypes in children.
- To evaluate proton pump inhibitor (PPI) responsiveness in these pediatric patients.
- To assess the frequency of microscopic esophagitis in children with nonerosive esophageal phenotypes.
Main Methods:
- Retrospective review of pediatric patients (≥5 years) undergoing esophagogastroduodenoscopy and multichannel intraluminal impedance testing.
- Exclusion of patients on PPI therapy; inclusion of those with symptoms during testing.
- Categorization into nonerosive reflux disease, reflux hypersensitivity, and functional heartburn based on Rome IV criteria.
Main Results:
- Functional heartburn was the most prevalent phenotype (44%), followed by reflux hypersensitivity (29%) and nonerosive reflux disease (27%).
- Older children reported more heartburn, while younger children experienced more nonspecific pain.
- No significant differences were observed in PPI responsiveness or microscopic esophagitis across the phenotypes.
Conclusions:
- Functional heartburn is the predominant Rome IV nonerosive esophageal phenotype in the pediatric population.
- Microscopic esophagitis and PPI responsiveness are not reliable predictors of specific nonerosive esophageal phenotypes in children.
- Further research may elucidate phenotype-specific treatment strategies for pediatric GERD.
Objectives:
To assess the prevalence of Rome IV nonerosive esophageal phenotypes in children using multichannel intraluminal impedance testing and to describe the rates of proton pump inhibitor (PPI) responsiveness and the frequency of microscopic esophagitis in these patients.
Study Design:
We conducted a retrospective review of all children ≥5 years of age who underwent esophagogastroduodenoscopy and multichannel intraluminal impedance testing off PPI therapy for evaluation of typical gastroesophageal reflux symptoms. Only children with symptoms during the multichannel intraluminal impedance testing were included. Children were categorized into the following nonerosive esophageal phenotypes using Rome IV criteria: nonerosive reflux disease, reflux hypersensitivity, and functional heartburn. Rates of esophagitis and responsiveness to acid suppression therapy were assessed.
Results:
Forty-five children were included: 27% were categorized as having nonerosive reflux disease, 29% with reflux hypersensitivity (27% acid and 2% nonacid), and 44% with functional heartburn. Older children reported significantly more heartburn (P < .001) than younger children, whereas younger children were more likely to report nonspecific pain (P = .047). There were no differences between groups in other reflux symptoms, rates of responsiveness to PPIs, or the presence of microscopic esophagitis on biopsy.
Conclusions:
Functional heartburn is the most common Rome IV nonerosive esophageal phenotype in children. Neither microscopic esophagitis nor PPI responsiveness can predict phenotype in pediatric patients.
Related Concept Videos
01:26Esophageal Strictures-II: Clinical Features and Management
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
01:21Barrett Esophagus-II: Clinical Manifestations and Management
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...
01:30Esophageal Strictures-I: Introduction
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...
01:21Barrett Esophagus-I: Introduction
This constant acid exposure transforms the esophagus's pink mucosal lining (stratified squamous epithelium) into a type of lining more...
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
01:29Gastroesophageal Reflux Disease II: Clinical Features and Management
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...