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Gastroesophageal reflux in children: results of a standardized fluoroscopic approach
Insights
Gastroesophageal reflux is common in children, occurring in 65% of cases, with or without symptoms. Reflux decreases with age, and an esophageal "beak" increases its incidence.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
Background:
- Gastroesophageal reflux (GER) is a common condition in children.
- Standardized diagnostic criteria for GER are essential for accurate assessment.
Purpose of the Study:
- To determine the incidence of GER during upper gastrointestinal examinations in children.
- To compare GER detection in symptomatic versus asymptomatic patients.
- To evaluate the impact of a lower esophageal "beak" on GER.
Main Methods:
- Retrospective analysis of 470 children undergoing barium upper gastrointestinal examinations.
- Standardized examination protocol to assess GER.
- Comparison of GER incidence and severity based on symptoms, age, and presence of an esophageal "beak".
Main Results:
- 65% of children exhibited GER.
- GER was more prevalent and severe in symptomatic children (75.9%) compared to asymptomatic ones (36.8%).
- GER incidence decreased with increasing patient age, with age-specific criteria proposed.
- An esophageal "beak" was associated with a higher incidence of GER (94.4%).
Conclusions:
- GER is frequent in pediatric patients, irrespective of symptoms.
- Age-specific criteria for acceptable GER levels are recommended.
- The presence of an esophageal "beak" is linked to increased GER and may have prognostic significance.
Abstract:
This retrospective study of 470 children undergoing barium upper gastrointestinal examinations was performed with three goals in mind: (1) to document the incidence of gastroesophageal reflux discovered during standardized upper gastrointestinal examination; (2) to compare the amount of gastroesophageal reflux detected in patients with symptoms suggestive of reflux as opposed to those who had no such symptoms; and (3) to ascertain the effect on reflux of the presence of a lower esophageal "beak." About 65% of the children studied had gastroesophageal reflux. Reflux was seen more commonly when symptoms of reflux were present (75.9%) than when not (36.8%). The amount of reflux seen over 5 min was greater if symptoms were present (mean incidence 2.72 bouts) than when not (mean incidence 0.76 bouts). Most importantly, there was a significant decrease in the amount of reflux seen with increase in patient age; age-related criteria for "acceptable" gastroesophageal reflux are presented. The presence of an esophageal "beak" is associated with an increased amount of reflux (94.4%) as opposed to no such "beak" (67.8%). The data suggest that gastroesophageal reflux is present in a large percentage of pediatric patients, whether there are symptoms to suggest reflux or not. Since reflux diminishes with increasing age, age-related criteria for an "acceptable" amount of reflux should be used rather than a universal judgment based on three episodes. Reflux to the cervical esophagus occurs frequently, both with and without symptoms of reflux, and may not be a reliable solitary indication for therapy. An esophageal "beak" is associated with an increase in reflux and may have important prognostic implications.