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Brief Resolved Unexplained Events Symptoms Frequently Result in Inappropriate Gastrointestinal Diagnoses and
Daniel R Duncan1, Clare Golden1, Amanda S Growdon2
1Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA.
Insights
Presenting symptoms in infants with brief resolved unexplained events (BRUE) influence diagnostic testing and gastroesophageal reflux disease (GERD) diagnoses, but are unreliable for diagnosing oropharyngeal dysphagia. GERD diagnoses, linked to symptoms, increase acid suppression medication use.
Area of Science:
- Pediatrics
- Gastroenterology
- Neurology
Background:
- Brief resolved unexplained event (BRUE) is a common presentation in infants.
- Oropharyngeal dysphagia and gastroesophageal reflux disease (GERD) are potential underlying causes.
- The role of presenting symptoms in diagnosing these conditions in BRUE infants is unclear.
Purpose of the Study:
- To investigate the association between presenting symptoms and diagnoses of oropharyngeal dysphagia and GERD in infants with BRUE.
- To examine the relationship between presenting symptoms, diagnostic testing (VFSS), and acid suppression medication use.
Main Methods:
- Prospective cohort study of 157 infants with BRUE.
- Review of presenting symptoms, videofluoroscopic swallow study (VFSS) results, and GERD diagnoses.
- Parental survey to determine acid suppression medication use.
- Logistic regression models to assess associations.
Main Results:
- Presenting symptoms were associated with the decision to perform VFSS but not with abnormal VFSS results.
- 42% of infants received a GERD diagnosis, and 33% were treated with acid suppression.
- Presenting symptoms and GERD diagnoses were linked to increased acid suppression use (aOR 2.3).
Conclusions:
- Presenting symptoms guide VFSS decisions in BRUE but are insufficient for diagnosing oropharyngeal dysphagia.
- Symptoms may lead to GERD diagnoses, which are associated with higher rates of acid suppression medication use.
Objective:
To determine associations between presenting symptoms and oropharyngeal dysphagia diagnoses, gastroesophageal reflux disease (GERD) diagnoses, and treatment with acid suppression medication in infants with brief resolved unexplained event (BRUE).
Study Design:
We performed a prospective cohort study of infants with BRUE to review presenting symptoms and their potential impact on testing and treatment. Videofluoroscopic swallow study (VFSS) results and explanatory diagnoses were obtained from medical record review; acid suppression use was determined by parental survey. Binary and multivariable logistic regression models were used to evaluate associations between presenting symptoms and obtaining VFSS, VFSS results, GERD diagnoses, and acid suppression medication.
Results:
Presenting symptoms were varied in 157 subjects enrolled at 51.0 ± 5.3 days of age, with many symptoms that may be related to GERD or dysphagia. Of these, 28% underwent VFSS with 71% abnormal. Overall, 42% had their BRUE attributed to GERD, and 33% were treated with acid suppression during follow-up. Presenting symptoms were significantly associated with the decision to obtain VFSS but not with abnormal VFSS results. Presenting symptoms were also associated with provision of GERD explanatory diagnoses. Both presenting symptoms and GERD explanatory diagnoses were associated with acid suppression use (aOR 2.3, 95% CI 1.03-5.3, P = .04).
Conclusions:
Presenting symptoms may play a role in clinicians' decisions on which BRUE patients undergo VFSS but are unreliable to make a diagnosis of oropharyngeal dysphagia. Presenting symptoms may also influence assignment of GERD explanatory diagnoses that is associated with increased acid suppression medication use.
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