544 EVALUATION OF FOUR DIAGNOSTIC STUDIES FOR CHILDREN WITH SUSPECTED GASTROESOPHAGEAL REFLUX (GER)

Abstract

No systematic evaluation of one (1 hr. pH) and twenty-four hour (24 hr. pH) esophageal pH probe tests, barium esophagrams and esophageal manometrics (EM) has been made in pediatric age patients. We therefore studied twenty-two children without gastrointestinal disease (WNL) and twenty-seven with symptoms of GER. The former differed from the latter in thirteen of seventeen parameters analyzed on the 24 hr. pH studies (F = 10.40; p < 0.001). Twenty-one of the twenty-seven symptomatic children had positive 1 hr. pH studies (sensitivity = 77.7%) while all (WNL) ones had negative tests (specificity = 100%). Lower esophageal sphincter pressures were similar during EM in both groups (21.1 ± 1.7 mm Hg vs 21.7 ± 1.7; p > 0.5). Motility patterns were also similar. GER was seen on esophagrams in eighteen symptomatic children (sensitivity = 50%) and thirteen (WNL) ones (specificity = 18%).Conclusions:1. 24 hr. pH studies are the most sensitive and specific method for diagnosing gastroesophageal reflux in children.2. One hr. pH probe studies are very specific but lack some sensitivity.3. Esophageal manometrics are not useful for diagnosing GER during the pediatric years.4. Barium esophagrams are neither sensitive nor specific in diagnosing gastroesophageal reflux among pediatric age patients.