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Evaluating the yield of gastrointestinal testing in pediatric patients in aerodigestive clinic
Emily M DeBoer1,2,3, Sarah Kinder2,4, Alison Duggar2
1Breathing Institute, Children's Hospital Colorado, Aurora, Colorado.
Insights
Gastrointestinal testing in children with airway issues often yields normal results, even with acid suppression. Children with feeding difficulty, TEF/EA, or asthma are more likely to have abnormal findings on esophageal evaluations.
Area of Science:
- Pediatric Aerodigestive Medicine
- Gastroenterology
- Pulmonology
Background:
- Airway and esophageal conditions frequently coexist in pediatric patients.
- Understanding the diagnostic yield of gastrointestinal (GI) testing in children with airway conditions is crucial for optimizing patient care.
- A significant number of children with airway issues undergo GI evaluations, necessitating an assessment of their effectiveness.
Purpose of the Study:
- To evaluate the diagnostic yield of procedural and radiographic gastrointestinal tract testing in children presenting with airway conditions.
- To analyze the relationship between referring diagnoses and the findings from esophageal evaluations in a pediatric aerodigestive clinic.
Main Methods:
- Retrospective chart review of 325 patients seen in a pediatric aerodigestive program (2010-2013).
- Evaluation of esophagogastroduodenoscopies with biopsies (EGD), upper gastrointestinal fluoroscopy studies (UGI), and pH multichannel intraluminal impedance probe (pH-MII) results.
- Analysis of test outcomes based on presenting diagnoses.
Main Results:
- Most patients (58.1%) were on acid suppression; many had a referring diagnosis of gastroesophageal reflux disease but normal evaluations.
- Abnormal pH-MII findings were most common in asthma patients; abnormal EGD findings were most common in those with feeding difficulty and tracheoesophageal fistula/esophageal atresia (TEF/EA).
- The majority of pH-MII (74.6%) and UGI (87%) studies were normal, while EGDs were normal in 63.7%.
Conclusions:
- Children with feeding difficulty, TEF/EA, and asthma are most likely to exhibit abnormalities on EGD or pH-MII.
- Many children with airway conditions, even those on acid suppression for presumed reflux, have normal GI evaluations.
- Further prospective studies are needed to refine diagnostic and treatment strategies for this complex pediatric population.
Objective:
To improve understanding of the interrelatedness of airway and esophageal diagnoses by evaluating the yield of procedural and radiographic testing of the gastrointestinal tract in children with airway conditions by their referring diagnoses in a pediatric aerodigestive clinic.
Methods:
A retrospective chart review of all 325 patients seen in the aerodigestive program from 2010 to 2013 was performed in a single academic medical center. Demographics and results from esophagogastroduodenoscopies with biopsies (EGD), upper gastrointestinal fluoroscopy studies (UGI), and pH multichannel intraluminal impedance probe (pH-MII) performed within 30 days of the clinic visit were evaluated according to presenting diagnoses.
Results:
Mean patient age was 3.15 years (range 0.15-24 years) and 41.2% were born premature. 189/325 (58.1%) were on acid suppression. A total of 295 EGD, 193 pH-MII, and 54 UGI were performed. The most common diagnosis with an abnormal pH-MII was asthma. The most common diagnoses with an abnormal EGD were feeding difficulty and tracheal esophageal fistula/ esophageal atresia (TEF/EA). EGDs were normal in 188/295 (63.7%), while 39/295 (13.2%) demonstrated esophagitis, and 22/295 (7.5%) had >15 esophageal eosinophils per high power field. The majority of pH-MII (144/193 [74.6%]) and UGI (47/54 [87%]) were normal.
Conclusions:
Children with feeding difficulty, TEF/EA, and asthma were the mostly likely to have a histologic abnormality on EGD or an abnormal pH-MII. The majority of children were previously prescribed acid suppression medication and had a referring diagnosis of gastroesophageal reflux disease but were subsequently found to have normal evaluation. Prospective studies are needed to optimize care of this population.
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