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Gastroesophageal reflux in infants and children comparative accuracy of diagnostic methods
Insights
The acid reflux test best identifies gastroesophageal reflux (GER) symptoms in children. Combining upper gastrointestinal series and GE scintiscan enhances GER detection, while endoscopy is superior for diagnosing esophagitis.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Gastrointestinal Motility Disorders
Background:
- Gastroesophageal reflux (GER) is common in infants and children, presenting diagnostic challenges.
- Accurate diagnosis of GER is crucial for appropriate management and preventing complications.
Purpose of the Study:
- To evaluate the diagnostic accuracy of various methods for detecting GER in pediatric patients.
- To compare the effectiveness of different diagnostic tools in identifying GER and its complications like esophagitis.
Main Methods:
- Thirty infants and children with GER symptoms underwent upper gastrointestinal series (UGI), gastroesophageal scintiscan (GE scintiscan), lower esophageal sphincter pressure (LESP) measurement, esophageal intraluminal pH monitoring (acid reflux test), and endoscopy.
- Fifteen age-matched control patients were also evaluated using the same diagnostic modalities.
Main Results:
- The acid reflux test showed the highest correlation with GER symptoms (29/30 patients).
- UGI detected GER in 15 patients, while GE scintiscan identified it in 17 patients; their combination improved sensitivity.
- Endoscopy revealed esophagitis in 15/21 patients, significantly more than UGI (2/30 patients). Normal LESP did not exclude GER.
Conclusions:
- The acid reflux test is the most symptom-correlated diagnostic method for pediatric GER.
- Combining UGI and GE scintiscan offers complementary diagnostic value for GER detection.
- Endoscopy is more sensitive than UGI for diagnosing GER-related esophagitis in children.
Abstract:
To assess the diagnostic accuracy of methods employed for detection of gastroesophageal reflux, 30 infants and children with symptoms of GER were evaluated by upper gastrointestinal series, gastroesophageal scintiscan, measurement of mean resting lower esophageal sphincter pressure, esophageal intraluminal PH measurement (acid reflux test), and endoscopy. Fifteen control patients were also evaluated by the above studies. GER was demonstrated by UGI in 15 and by GE scintiscan in 17 study patients. LESP less than 15 mm Hg was noted in 12 and a positive acid reflux test was obtained in 29 study patients. Esophagitis was detected in two (of 30) study patients radiographically and in 15 (of 21) study patients by upper gastrointestinal endoscopy. Pulmonary aspiration of gastric contents was not detected by the radionuclide method. None of the 15 control patients had GER demonstrated with any of the above methods. These studies indicate that (1) the acid reflux test correlates most closely with symptoms of GER; (2) THE GE scintiscan is complementary to the UGI in the diagnosis of GER, i.e., the combination increases sensitivity; (3) normal LESP does not necessarily exclude GER; and (4) endoscopy is superior to the UGI in detecting the presence of esophagitis.