Diagnostic Modalities for Gastroesophageal Reflux

Overview

Journal Indian J Pediatr

Specialty Pediatrics

Date 2002 Apr 4

PMID 11929028

Citations 1

Authors

A K Patwari

Pramila Bajaj

Ravi Kashyp

V K Anand

Ashutosh Gangil

Amit Jain

Gaurav Kapoor

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate commonly utilized diagnostic modalities to detecting Gastroesophageal Reflux (GER).

Methods: Sixty children aged 1-72 months (mean age 14.7 months) with symptoms suggestive of Gastroesosphageal Reflux (GER) were investigated and subjected to upper gastrointestinal endoscopy and esophageal biopsy (EB), gastroesophageal scintiscanning (GS) and 24 hour ambulatory pH monitoring.

Result: GER was detected in 28 (46.7%) cases by one or more diagnostic modalities. Ambulatory 24 hour pH monitoring was positive in higher proportion (43.3%) of cases in comparison to other modalities, followed by EB (38.3%) and GS (30%). Considering 24 hour pH monitoring as the gold standard, esophageal biopsy was positive in 22/26 cases (84.6%) detected by 24 hour pH monitoring with a specificity of 97.1% as compared to 17/26 cases (65.4%) by gastroesophageal scintiscanning with a specificity of 97.1%. When compared with EB results, amongst various parameters measured during 24 hour pH monitoring, Reflux index (RI) ranked highest (sensitivity 95.6 % and specificity 89.2 %) followed by duration of longest episode > 20 minutes and Euler Byrne score. Oscillatory index, calculated from tracings of pH monitoring, even though ranked lower because of its low sensitivity helped to pick up 2 cases missed by EB and RI.

Conclusion: Our results suggest that a combination of diagnostic modalities may be required to diagnose GER in young children. Ambulatory 24 hour pH monitoring appears to be the single best investigation and combining it with EB and/or GS can help to detect maximum number of cases.

Citing Articles

Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and....

Rosen R, Vandenplas Y, Singendonk M, Cabana M, DiLorenzo C, Gottrand F J Pediatr Gastroenterol Nutr. 2018; 66(3):516-554.

PMID: 29470322 PMC: 5958910. DOI: 10.1097/MPG.0000000000001889.

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