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Published on: December 14, 2020
Overlapping Symptoms of Gastroesophageal Reflux and Aspiration Highlight the Limitations of Validated Questionnaires
Daniel R Duncan1, Courtney DiFilippo, Madeline Kane
1Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA.
Insights
The Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R) shows a strong correlation with oropharyngeal dysphagia in infants, suggesting it may identify swallowing issues beyond reflux. This helps in diagnosing infant feeding difficulties more accurately.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Otolaryngology
- Pediatric Neurology
Background:
- Infants often present with feeding and respiratory issues, commonly misdiagnosed as gastroesophageal reflux.
- Oropharyngeal dysphagia with aspiration can mimic symptoms of gastroesophageal reflux disease (GERD).
- The Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R) is a tool for assessing GERD, but its utility in identifying dysphagia is under investigation.
Purpose of the Study:
- To investigate the correlation between the I-GERQ-R and objective measures of dysphagia.
- To determine if the I-GERQ-R can identify oropharyngeal dysphagia in infants presenting with feeding difficulties.
- To compare I-GERQ-R results with the Pediatric Eating Assessment Tool-10 (Pedi-EAT-10) and videofluoroscopic swallow study (VFSS) findings.
Main Methods:
- A prospective study was conducted on infants under 18 months with feeding difficulties.
- Parents completed the Pedi-EAT-10 and I-GERQ-R questionnaires.
- I-GERQ-R scores were compared with Pedi-EAT-10 scores and, when available, with VFSS results.
Main Results:
- A significant correlation was found between the I-GERQ-R and Pedi-EAT-10 scores (r=0.218, P=0.023), and a stronger correlation in subjects with prior VFSS (r=0.369, P=0.001).
- Specific I-GERQ-R questions related to "blue spells" showed potential for predicting aspiration/penetration on VFSS with 100% specificity.
- Infants with abnormal VFSS results had significantly higher scores on I-GERQ-R questions regarding crying during/after feedings.
Conclusions:
- The I-GERQ-R and Pedi-EAT-10 demonstrate a high degree of correlation in infants with feeding difficulties.
- Findings suggest that the I-GERQ-R may reflect oropharyngeal dysphagia, not solely gastroesophageal reflux disease, in infants.
- The I-GERQ-R could serve as a valuable screening tool for dysphagia in infants presenting with symptoms suggestive of reflux.
Objectives:
Infants frequently present with feeding difficulties and respiratory symptoms, which are often attributed to gastroesophageal reflux but may be because of oropharyngeal dysphagia with aspiration. The Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R) is a clinical measure of gastroesophageal reflux disease but now there is greater understanding of dysphagia as a reflux mimic. We aimed to determine the degree of overlap between I-GERQ-R and evidence of dysphagia, measured by Pediatric Eating Assessment Tool-10 (Pedi-EAT-10) and videofluoroscopic swallow study (VFSS).
Methods:
We performed a prospective study of subjects <18 months old with feeding difficulties. All parents completed Pedi-EAT-10 and I-GERQ-R as a quality initiative to address parental feeding concerns. I-GERQ-R results were compared with Pedi-EAT-10 and, whenever available, results of prior VFSS. Pearson correlation coefficients were calculated to determine the relationship between scores. Groups were compared with 1-way ANOVA and Fisher exact test. ROC analysis was completed to compare scores with VFSS results.
Results:
One hundred eight subjects with mean age 7.1 ± 0.5 months were included. Pedi-EAT-10 and I-GERQ-R were correlated (r = 0.218, P = 0.023) in all subjects and highly correlated in the 77 subjects who had prior VFSS (r = 0.369, P = 0.001). The blue spell questions on I-GERQ-R had relative risk 1.148 (95% confidence interval [CI] 1.043-1.264, P = 0.142) for predicting aspiration/penetration on VFSS, with 100% specificity. Scores on the question regarding crying during/after feedings were also higher in subjects with abnormal VFSS (1.1 ± 0.15 vs 0.53 ± 0.22, P = 0.04).
Conclusions:
I-GERQ-R and the Pedi-EAT-10 are highly correlated. I-GERQ-R results may actually reflect oropharyngeal dysphagia and not just gastroesophageal reflux disease in infants.
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