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Diagnosis of gastroesophageal reflux in pediatrics
T C Stephen1, M K Younoszai, M P Massey
1Department of Pediatrics, University of Louisville School of Medicine, KY 40292.
Insights
Differentiating pathogenic gastroesophageal reflux (GER) in infants is crucial. Prolonged esophageal pH monitoring is the most reliable method for detecting pathogenic GER, outperforming barium and meal studies.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Clinical Medicine
Background:
- Gastroesophageal reflux (GER) presents in normal, functional, and pathogenic forms.
- Pathogenic GER can lead to severe health issues in infants and children, including failure-to-thrive and respiratory problems.
- Distinguishing pathogenic GER from normal or functional GER is clinically essential.
Purpose of the Study:
- To evaluate the diagnostic utility of different tests for identifying pathogenic gastroesophageal reflux (GER) in infants and children.
- To compare the effectiveness of barium studies, meal scintigraphy, and prolonged esophageal pH monitoring in detecting pathogenic GER.
Main Methods:
- A study involving 89 infants and children with suspected pathogenic GER.
- Utilized upper gastrointestinal roentgenogram (barium GER), esophageal scintigraphy (meal GER), and prolonged lower esophageal pH probe monitoring (acid GER).
- Analyzed the prevalence of significant findings for each test and assessed statistical correlations between them.
Main Results:
- Significant acid GER was detected in 70% of patients.
- Barium GER and meal GER were found in 36% and 17% of patients, respectively.
- No statistically significant correlations were found between acid GER, barium GER, and meal GER, suggesting they detect different phenomena.
Conclusions:
- Current diagnostic tests for GER, including barium and meal studies, may represent different pathophysiological processes.
- Prolonged esophageal pH monitoring is indicated as the most reliable and gold standard diagnostic tool for identifying pathogenic GER.
- Clinical differentiation of GER types is vital for appropriate management and treatment decisions.
Abstract:
Gastroesophageal reflux (GER) may be normal, functional, or pathogenic. Normal GER is of short duration and seen in all individuals. Functional GER, or effortless regurgitation, is common during infancy, causing no ill effects. Pathogenic GER causes diseases such as failure-to-thrive, coughing, choking, aspiration, apnea and/or bradycardia, esophagitis with irritability and excessive crying. Clinically it becomes imperative to distinguish normal and functional from pathogenic GER. The tests presently employed to detect GER are roentgenogram of the upper gastrointestinal tract (showing barium GER), scintigraphy of the esophagus after ingestion of a 99mTc labeled meal (indicating meal GER) and prolonged pH probe monitoring the lower esophagus (depicting acid GER). There seems to be a controversy regarding the usefulness of these tests for the diagnosis of pathogenic GER. In the present study of 89 infants and children presenting with signs and symptoms of pathogenic GER, 70% had significant acid GER, while 36% and 17% had barium and meal GER respectively. No statistically significant correlations were detected between acid GER, barium GER, and meal GER. We conclude that these three tests probably represent different phenomena, and that prolonged esophageal pH monitoring should be considered the most reliable and gold standard for detection of pathogenic GER.
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