Gastroesophageal Reflux Disease In Children Research Articles

Perioperative outcomes of laparoscopic fundoplication for gastroesophageal reflux disease in children with or without scoliosis.

This study aimed to evaluate the perioperative outcomes of laparoscopic fundoplication (LF) for gastroesophageal reflux disease (GERD) in children with scoliosis. Data of consecutive patients with GERD who underwent LF from January 2015 to December 2020 at a single pediatric institution were retrospectively analyzed. Eighty-two patients underwent laparoscopic Nissen fundoplication. The median [interquartile range (IQR)] body weight was 9.3 [7; 14] kg. Seventy-five patients wereneurologically impaired (91%), and other comorbidities included scoliosis (n = 33), lung disease (n = 39), and cardiac disease (n = 14). The median (IQR) operative time including the creation of the gastrostomy and volume of bleeding were 160 [143; 190] min and 2 [1; 5] mL, respectively. There were no significant differences between patients with and those without scoliosis (p = 0.17 and p = 0.90, respectively). Patients with cardiac disease had a longer operative time (167 [161; 193] vs. 157 [141; 190] min, p = 0.01). There were three post-operative complications in children with neurological impairment; however, there was no clear relationship between the severity of scoliosis and complications. Severity of scoliosis did not correlate with perioperative results and post-operative complications. This suggests that the same LF technique can be used regardless of the presence or absence of scoliosis in children.

Undifferentiated connective tissue dysplasia as a predictor of heart rate disorders in combination with gastroesophageal reflux disease in children

The aim: to improve the early diagnosis of arrhythmia in combination with gastroesophageal reflux disease (GERD) in children, by studying the risk of connective tissue dysplasia on the occurrence of this pathology.
 Materials and methods. We examined 100 children aged 8 to 18 years, mean age 13.7±2.7 years, of which 32 children with arrhythmias without combined pathology were group I, 36 children with concomitant GERD - group II and 32 children with GERD without concomitant arrhythmias - group III. Patients underwent clinical and instrumental studies (electrocardiography, Holter daily ECG monitoring, esophagogastroduodenoscopy and pH-metry) and evaluation of phenotypic signs of NDST according to the criteria of T. Milkovskaya-Dimitrova and A. Karkasho.
 Results. A risk factor for the formation of combined pathology in children in the form of arrhythmia and GERD was identified, namely the next main phenotypic feature of NDST (undifferentiated connective tissue dysplasia) – dysplastic tooth growth.
 Also, predictors of both an isolated variant of arrhythmia in children and arrhythmia in combination with GERD – high height and scoliotic posture were identified.
 In this case, the risk factor for an isolated variant of arrhythmia in children, according to the results of the study is asthenic constitution.
 The severity of NDST in the studied groups was determined. The analysis of the results revealed the absence of a statistically significant relationship between the severity of NDST and study groups, although it should be noted that in children of group III the first degree of NDST was not observed in general.
 Conclusions. It was found that asthenic constitution, dysplastic tooth growth, tall stature and scoliotic posture are statistically significant risk factors for the development of the studied pathologies.
 There were no statistically significant differences between the study groups regarding the severity of NDST, but there was a complete lack of detection in children of group III (children with isolated GERD without concomitant arrhythmia) of the first degree of NDST

Diagnosis and Management of Gastroesophageal Reflux Disease in Children: Recommendations of Pediatric Gastroenterology Chapter of Indian Academy of Pediatrics, Indian Society of Pediatric Gastroenterology, Hepatology and Nutrition (ISPGHAN)

Gastroesophageal reflux (GER) related symptoms are a major cause of parental concern and referrals at all ages. These guidelines have been framed to inform pediatricians regarding current diagnosis and management of gastro-esophageal reflux disease (GERD). A group of experts from the pediatric gastroenterology sub-specialty chapter of Indian Academy of Pediatrics (ISPGHAN) discussed various issues relating to the subject online on 25 October, 2020. A consensus was reached on most aspects and a writing committee was constituted. This committee had three meetings for a detailed discussion. The statement was sent to the entire group and their approval obtained. To formulate a consensus statement to enable proper diagnosis and management of GERD in children. GER is physiological in most infants and it improves as age advances. The pathological form, called GERD causes distressing symptoms that affect daily activities and may result in complications. The presentation would vary from regurgitation to severe symptoms due to esophageal or respiratory tract disease. In older children, esophagitis is the commonest manifestation of GERD. A careful history and clinical examination are adequate to make a diagnosis in most patients, but judicious investigations are necessary in a few. Upper gastro intestinal tract endoscopy may be required in those with esophageal manifestations, dysphagia and hematemesis. In children with extra-esophageal symptoms, MII-pH monitoring and scintigraphy are necessary. Empirical treatment with a Proton pump inhibitor (PPI) has not been proven useful in infants, but a four-week trial is recommended in older children without complications. While positioning and feed thickening have limited benefit in infants, life-style modifications are important in older children.

Prokinetics in Childhood Gastroesophageal Reflux Disease: Are They Indicated?

Prokinetics in Childhood Gastroesophageal Reflux Disease: Are They Indicated?

Prokinetics in Childhood Gastroesophageal Reflux Disease: Are They Indicated?

Prokinetics in Childhood Gastroesophageal Reflux Disease: Are They Indicated?

Extraesophageal signs of gastroesophageal reflux disease: otorhinolaryngologist's view

The data on association between various pathologies of the ENT organs and gastroesophageal reflux disease (GERD) is analysed in the article. The variety of extraesophageal signs of GERD in children and adults is given, what is advisable to inform physicians of different specialties about the possibilities of antireflux therapy. These options are expanded with the emergence of a unique new drug, Alfasoxx. Its bioadhesive formula is based on hyaluronic acid and chondroitin sulphate thereby protecting the esophageal mucosa. Alfasoxx acts on the surface of the esophageal mucosa without penetrating into the systemic bloodstream and it also has a low allergenic potential, which has been confirmed by numerous studies. With its healing and repairing effect on erosive lesions of the esophageal epithelium, Alfasoxx in combination with proton pump inhibitors is more effective in achieving regression of clinical manifestations of the disease and improving patients quality of life (according to SF-36 questionnaire) compared to proton pump inhibitors monotherapy.

Understanding gastroesophageal reflux disease in children.

Gastroesophageal reflux disease (GERD) is a common disorder with increasing prevalence in children. The diagnosis and management of GERD remains a challenge because of its nonspecific symptomatology from infancy through adolescence. Certain presenting alarm symptoms warrant a further, more extensive workup. Treatment of pediatric GERD begins with lifestyle and nonpharmacologic management, including postural adjustments, dietary changes, and weight loss if indicated. Pharmacologic interventions can be prescribed to relieve symptoms for patients whose disease does not respond to lifestyle management. Patients with refractory symptoms can be managed with surgical intervention. Complications may arise if GERD remains untreated, ranging from worsening oral health to failure to thrive.

Периферическая электрогастроэнтерография в диагностике гастроэзофагеальной рефлюксной болезни у детей

Study Objective: To assess the relation between clinical manifestations of gastroesophageal reflux disease (GERD) and specific gastrointestinal (GIT) motility in children using electrogastroenterography (EGEG). Study Design: observational comparative study. Materials and Methods. We examined 55 children at the age of 7 to 17 years old with confirmed GERD. All patients underwent EGEG. In order to study the specificity of GIT motility and evacuation in patients with traditional signs of GERD, we compared complaints with fasting and postprandial EGEG results. Complaints included heartburn, belching, nausea, and vomiting. Study Results. The study made it possible to identify statistically significant correlations between clinical manifestations of GERD in children and EGEG results. Patients complaining of fasting heartburn had electric activity (Р(I)/PS, %) at ileum frequencies that was significantly lower than in children who did not complain of heartburn (р = 0.033); these changes evidence impaired ileum motility. P(I)/P(I + 1) jejunum /ileum ratio in patients with heartburn was significantly higher than without heartburn (р = 0.043), thus evidencing dislocated motility in these GIT sections. Children with fasting belching demonstrated a significant increase in the rhytmicity coefficient (Kritm) at the frequencies of the duodenum, jejunum and ileum (р = 0.042, р = 0.035, р = 0.036, respectively), thus evidencing non-propulsive contractions in these GIT sections. Patients with postprandial nausea, P(I)/P(I + 1) duodenum/ jejunum was significantly lower than in patients without complaints (р = 0.029). In children with fasting vomiting, Р(I)/PS, % at the stomach and duodenum frequencies was significantly higher than in children who did not have this problem (р = 0.028, р = 0.036, respectively); therefore, motility in these sections was increased. Patients complaining of vomiting demonstrated higher P(I)/P(I + 1) duodenum/ jejunum (р = 0.048). In patients with vomiting, Kritm in all GIT sections was significantly lower than in children not complaining of vomiting. Conclusion. Children with GERD who complained of vomiting and belching demonstrated the highest number of significant changes in fasting EGEG results, namely Р(I)/PS, % at the stomach and duodenum frequencies; and Kritm of all GIT sections. These changes evidence impaired motility, its incoordination, non-propulsive contractions, justifying prescription of medicines that can correct impaired motility. Keywords: gastroesophageal reflux disease, motility, gastrointestinal tract, peripheral electrogastroenterography, children.

Treatment of Gastroesophageal Reflux Disease in Children.

1. Elizabeth A. Berg, MD* 2. Julie Khlevner, MD* 1. *Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Columbia University Irving Medical Center, New York, NY Gastroesophageal reflux (GER) is the physiologic process of gastric contents transferring upward, past the lower esophageal sphincter (LES), and into the esophagus. GER occurs naturally in more than 25% of infants, peaks at approximately 3 to 4 months of age, and usually self-resolves with time without pathologic consequences. When reflux symptoms become severe or complications such as esophagitis, refusal to eat, or weight loss develop, GER progresses to gastroesophageal reflux disease (GERD). Intractable GERD occurs when symptoms or complications of GERD persist despite optimal medical treatment. The prevalence of GERD is less than 5% in early school-aged children and approximately 10% in children older than 10 years. GERD is an umbrella term for a spectrum of manifestations that can be classified into categories based on symptoms, endoscopic findings, reflux monitoring, and underlying pathophysiology. The 4 major subtypes of GERD are 1) erosive reflux disease, 2) nonerosive esophageal reflux disease, 3) reflux hypersensitivity, and 4) functional heartburn. Functional heartburn is the most prevalent phenotype in children. Identifying a patient’s distinct GERD phenotype aids in selection of more effective treatment. GERD management should be based on the best available evidence, consistent with practice guidelines from the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). Nutritional management is the mainstay of nonpharmacologic treatment of GER in infants younger than 1 year. The initial approach involves …

Problemas na alimentação infantil e sua associação com a doença do refluxo

Objective: To identify infant feeding problems associated with gastroesophageal reflux disease in childhood. Bibliographic review: Gastroesophageal reflux disease (GERD) has a multifactorial cause and corresponds to a chronic dysfunction resulting from the retrograde flow of gastric content into the esophagus. Frequent exposure of gastric contents in the esophagus can cause a defect in the lower esophageal sphincter, which acts as an anti-reflux barrier. Therefore, this dysfunction may favor the occurrence of transitory relaxations of this sphincter, causing an increased predisposition to GERD. In children, gastroesophageal reflux manifests itself in a physiological way, however, when concomitant to different symptoms and complications, usually resulting from feeding problems, it can cause the development of GERD, whose most common manifestations are heartburn and regurgitation, symptoms that can influence negatively on the quality of life of the child and his family. Final considerations: GERD manifests itself in different ways, causing very wide signs and symptoms according to the age group. Therefore, it is essential to identify risk groups, be up-to-date with the guidelines, and provide guidance on adequate nutrition in order to minimize their complications and facilitate diagnosis.

Effect of omeprazole on symptoms of gastroesophageal reflux disease in children with cystic fibrosis. A randomized, double-blind, placebo-controlled trial.

The incidence of gastroesophageal reflux disease (GERD) is higher in patients with cystic fibrosis (CF) than in the general population. While the relationship between GERD and its typical symptom, heartburn, is beyond doubt, its effect on cough or abdominal pain is unclear. In CF patients, in particular, it is often difficult to confirm the causal relationship between GERD and these symptoms. The aim of this trial was to evaluate the effect of omeprazole treatment of GERD on abdominal pain and cough, in children with CF. This was a multicentre, randomized, double-blind, placebo-controlled trial. All children aged 4-18 years underwent 24-hour multichannel intraluminal pH-impedance monitoring. The patients with diagnosed GERD were randomly assigned to receive omeprazole (20 mg twice daily for 12 weeks) or placebo. The severity of symptoms was assessed on visual analog scale. 22 consecutive patients (median age 11.02± 3,67, range 6.4-17.0) were enrolled. A statistically significant reduction in abdominal pain and typical GERD symptoms, but not cough, was observed in both omeprazole (N=12) and placebo (N=10) groups. However, there were no statistically significant differences between the groups in the degree of reduction. We did not observe any differences between the groups in terms of adverse reactions. Treatment of GERD in children with CF seems not to have a stronger effect than a placebo on the severity of cough and abdominal pain. Considering this, as well as the previously raised concerns about the impact of chronic proton pump inhibitor treatment on the course of CF, perhaps one should be more careful in intensively treating suspected atypical GERD symptoms in patients with CF.

ЕФЕКТИВНІСТЬ ЗАСТОСУВАННЯ ІНГІБІТОРІВ ПРОТОННОЇ ПОМПИ У ДІТЕЙ З БРОНХІАЛЬНОЮ АСТМОЮ, ЩО ПОЄДНАНА З ГАСТРОЕЗОФАГЕАЛЬНОЮ РЕФЛЮКСНОЮ ХВОРОБОЮ ТА РЕФЛЮКС-ЕЗОФАГІТОМ

EFFICACY OF PROTON PUMP INHIBITORS IN CHILDREN WITH ASTHMA COMBINED WITH GASTROESOPHAGEAL REFLUX DISEASE AND REFLUX ESOPHAGITIS Yu. G. Antipkin, V. F. Lapshin, T. R. Umanets, А. А. Buratynska, N. G. Chumachenko, L. S. Stepanova, S. I. Tolkach O. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine Abstract. The most common comorbid pathology in children with asthma is gastroesophageal reflux disease associated with reflux esophagitis, which ranges from 32 % to 80 %. To date, the effectiveness of proton pump inhibitors in this category of children and their effect on the level of asthma control remains controversial. The aim is to study the effectiveness of treatment with proton pump inhibitors in children with asthma, combined with gastroesophageal reflux disease and reflux esophagitis. Materials and methods. Forty-six children aged 6–17 years with asthma combined with gastroesophageal reflux disease and reflux esophagitis were examined. They were taking omeprazole 20 mg once daily for 4-8 weeks to control the symptoms of gastroesophageal dysfunction. Criteria for the effectiveness of the prescribed treatment were the dynamics of symptoms of gastroesophageal reflux disease and the level of asthma control, which were assessed at 4 and 8 weeks of treatment. Assessment of symptoms of gastroesophageal reflux disease was performed according to the questionnaire. The degree of control of asthma was determined using the Asthma Control Test. Results and discussion. There was a complete regression of symptoms of gastroesophageal reflux disease after 4 weeks of treatment with omeprazole in 40 (87.0 %) patients. Only 6 (46.2 %) patients with severe asthma had episodic symptoms of gastroesophageal dysfunction after 4 weeks of omeprazole treatment that were not recorded at 8 weeks of treatment. An increase in the number of children with controlled asthma was observed with omeprazole treatment, but no significant difference was found. Conclusions. Proton pump inhibitors are effective in controlling the symptoms of gastroesophageal reflux disease in children with asthma, but not likely in the short-term level of asthma control. Key words: asthma, treatment, children, reflux esophagitis, gastroesophageal reflux disease.

Impact of risk factors in developing bronchial asthma combined with gastroesophageal reflux disease in children

The purpose of the study was to determine the risk factors affecting the development of asthma combined with gastroesophageal reflux disease (GERD). Seventy children aged 5-17 years with asthma were examined. They were divided to two groups: group 1 (50 children with asthma and GERD), and group 2 (20 children with isolated asthma). Medical history data were collected through specially designed questionnaire for parents. It was determined that the perinatal risk factors that likely contributed to developing co-morbid asthma and GERD were a threatened miscarriage (OR=6.65; 95% CI, 1.7-25.6, p=0.003), acute respiratory illnesses during pregnancy (OR=6.52; 95% CI, 1.4-31.2, p=0.008), polyhydramnios (p=0.039) and uterine inertia (p=0.0003). Food hypersensitivity in the first year of life, the severity of asthma in examined children played role in increasing the risk of developing asthma combined with GERD (OR=4.83; 95% CI, 1.3-18.6, p=0.013 and OR=4.45; 95% CI, 1.2-17.1, р=0.019 respectively).

Gastroesophageal Reflux Disease and Need for Antireflux Surgery in Children with Cystic Fibrosis: A Systematic Review on Incidence, Surgical Complications, and Postoperative Outcomes.

Introduction Gastroesophageal reflux disease (GERD) is associated with accelerated decline in lung health in children with cystic fibrosis (CF). Thus, antireflux surgery (ARS) is offered to a selected CF cohort with refractory GERD, but outcomes remain poorly investigated. This study aimed to determine the incidence of GERD in children with CF and to evaluate complications and outcomes of ARS. Materials and Methods A systematic literature-based search was conducted using various online databases according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The number of GERD cases in pediatric CF cohorts who underwent diagnostic investigation(s) was recorded. Data on postoperative complications and outcomes (including symptoms, lung function, and nutritional status) following ARS were analyzed. Results Ten articles ( n = 289 patients) met the defined inclusion criteria (51% male; age range, 0.5 month–36 years). The overall incidence of GERD was 46% (range, 19–81%), derived from seven studies ( n = 212 patients). Four publications ( n = 82 patients) reported on ARS due to uncontrolled GERD. All ARSs were Nissen fundoplication (majority with gastrostomy placement). Major postoperative complications occurred in 15 (18%) patients, two required redo-ARS. Median follow-up time was 2 years (range, 3 months–6 years); 59% showed symptom improvement, and pulmonary exacerbations and decline in lung function were reduced. Nutritional status mainly improved in milder CF cases. There were no deaths related to ARS. Conclusion Approximately half of pediatric CF patients have GERD. Published data for children with CF are limited and heterogeneous in terms of GERD diagnosis and outcomes following ARS. However, ARS has shown to slow the deterioration of lung function in CF.

Особливості клінічного перебігу бронхіальної астми, поєднаної з гастроезофагеальною рефлюксною хворобою, у дітей

Among the comorbid conditions in children with asthma a significant place is occupied by lesions of the upper digestive tract+in particular, gastroesophageal reflux disease (GERD). It is known that asthma can provoke the development of reflux, and reflux in turn leads to a worsening of the course of asthma. Scientific studies indicate a better ability to control asthma in children after appropriate treatment for GERD. Purpose — to study the features of the clinical course of asthma combined with gastroesophageal reflux disease in children. Materials and methods. Ninety+nine children aged 6–17 years with asthma of varying severity and level of control were examined. These children which were randomly divided into two groups: group 1–79 children with asthma combined with GERD, and group 2–20 children with asthma without GERD. A questionnaire was administered, an assessment of day and night symptoms of asthma according to the scoring system was conducted, and an ACT test according to age was performed on all examined children. With the consent of the parents, twenty-two children who had complaints characteristic of gastrointestinal lesions, underwent fibroesophagogastroduodenoscopy with biopsy from the proximal and distal esophageal mucosa. Results. In children with asthma combined with GERD, atopic dermatitis is probably more common (in 46.8% of patients), and symptoms of hypersensitive reactions to food are registered (in 74.6% of patients). Children in group 1, in contrast to children in group 2, had a longer and more severe course of asthma and probably more frequent nocturnal symptoms of the disease, which was associated with poorer control of asthma and the need for bronchodilator therapy (8.5±0.5 inhalations per month against 4.5±0.5 inhalations per month, respectively, p<0,05). Peculiarities of GERD in children with asthma were: nonspecific complaints, catarrhal changes of the lower third of the esophagus (reflux esophagitis in 98.7%), focal hyperplasia of the basal layer of the epithelium and intraepithelial eosinophilia up to 5% (9%). Girls and boys of different ages experience significant differences in complaints from the gastrointestinal tract. Conclusions. The presence of GERD has been shown to affect the control of asthma in children, associated with nocturnal symptoms, the need for bronchodilator therapy, more severe and prolonged course of the disease, concomitant atopic dermatitis and food hypersensitivity reactions. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Keywords. asthma, gastroesophageal reflux disease, children.

461 AMOUNTS OF FAT AND PROTEIN CONSUMPTION ARE HIGHER, BUT OF POLYUNSATURATED FATS LOWER IN CHILDREN WITH GERD COMPARED TO CONTROLS

Abstract In contrast to adults, characteristic features of diet in children with GERD are not widely studied. Still, they may play an important role in pathogenesis of the disease and are important from the viewpoint of possible non-pharmacological treatment. The aim of the study was to compare the rates of nutrients consumption in children and adolescents with gastroesophageal reflux disease (GERD) compared to the control group without the disease. Methods Based on symptom evaluation and esophageal pH-impedance recordings patients were allocated on to GERD and control groups. All patients underwent esophagogastroscopy. Levels of nutrients consumption were assessed with the use of food frequency questionnaire in the regard to the presence of the disease, oesophagitis, and z-score body mass index (BMI). Results Data of 219 children and adolescents were available for the final analysis. Energy values of the rations and amount of fat consumption were higher in the GERD group compared to the control when rations were compared according to z-score BMI. In contrast to nonerosive form of GERD, patients with erosive esophagitis consumed more protein (percentage deviation from the recommended daily allowance Me [25%;75%]): 14.3 (11.07; 19.1) % vs 8.5 (6.71; 14.1) %, total fat 36.8 (12.5; 75.5) % versus 16.9 (10.1; 17.9) %, and less polyunsaturated fats −54.3 (−73.4; −47.7) % vs −45.6 (−56.2; −33.1) %, P < 0.05. Conclusion The rations of children with GERD are characterized by higher calorie values and larger amounts of fat intake compared to the control group in the regard to z score BMI. Low dietary fibre consumption is additional factor associated with GERD in children with excessive weight and obesity. Compared to nonerosive GERD, higher intake of energy, protein, and total fat and lower of polyunsaturated fats revealed in patients with GERD with erosive esophagitis.

Allergic rhinitis as a key factor for the development of gastroesophageal reflux disease in children.

Gastroesophageal reflux disease (GERD) may cause airway symptoms and some airway diseases exacerbate GERD symptoms. Asthma and allergic rhinitis (AR) have been identified as united airway disease because of their similar epidemiology and pathophysiology. Asthma has been considered a risk factor to develop GERD. However, the association between AR and GERD is not clear. We tried to investigate whether AR could increase the development of GERD. Children diagnosed as AR without a prior history of GERD were conducted from the National Health Insurance Research Database between 2000 and 2005. After propensity score matching, we enrolled 36,588 children with AR and 36,588 non-AR children as the controls. Cox regression models were adopted to calculate the hazard ratio (HR) of GERD. AR children had a significantly increased risk of GERD than non-AR children (adjusted HR 1.91, 95% CI=1.73-2.11, p<0.001), especially in the age less than 6 years old (adjusted HR 2.68, 95% CI=1.64-4.38, p<0.001). The risk factor related to increased risk of GERD including age, gender, and chronic sinusitis. AR is a risk factor associated with the development of GERD in children.

Frequency of gastroesophageal reflux disease in children with adenoid hypertrophy

ObjectivesRecent studies have suggested that the reflux of gastric contents can cause adenoid hypertrophy (AH). The frequency of gastro-oesophageal reflux disease (GERD) in this AH population is unknown, but according to studies using pH-metry it may be as high as 65%. The aim of this study was to estimate the frequency of GERD among children with AH. MethodsThis was a cross-sectional, multicentre, prospective study of children with AH selected for adenoidectomy. The diagnosis of AH was made by a single laryngologist using a flexible fiberscope. All children had 24-hr multichannel intraluminal pH-impedance (MII/pH) assessment. A GERD diagnosis was made using BioVIEW software analysis after manual review by a single investigator. Results38 consecutive patients (21 males, mean age 6.58 years) were enrolled in the study. GERD was diagnosed in 5 (13.2%) patients. A total of 1462 gastro-oesophageal reflux events (GERs) were detected by MII/pH and the majority (60.9%) were acidic. The only significant differences between the GERD-positive and GERD-negative groups were the total number of GERs, and the number of acid GERs. ConclusionIt is first study using MII/pH to assess the frequency of GERD in children with AH. The data suggest that GERD in children with AH seems to be not as common as it was previously raised. Further studies are needed to confirm these results.

Detection of reflux-symptom association in children with esophageal atresia by video-pH-impedance study.

BACKGROUNDChildren with esophageal atresia (EA) have risk of gastroesophageal reflux disease (GERD), suggesting reflux monitoring for prompt management.AIMTo evaluate GERD in children with EA and specific symptom association from combined Video with Multichannel Intraluminal Impedance and pH (MII-pH) study.METHODSChildren diagnosed with EA with suspected GERD and followed up at King Chulalongkorn Memorial Hospital between January 2000 and December 2018 were prospectively studied. All underwent esophagogastroduodenoscopy with esophageal biopsy and Video MII-pH study on the same day. Symptoms of GERD which included both esophageal and extra-esophageal symptom were recorded from video monitoring and abnormal reflux from MII-pH study based on the statement from the European Paediatric Impedance Group. Prevalence of GERD was also reported by using histopathology as a gold standard. Endoscopic appearance was recorded using Los Angeles Classification and esophagitis severity was graded using Esohisto criteria.RESULTSFifteen children were recruited with age of 3.1 (2.2, 9.8) years (40%, male) and the common type was C (93.3%). The symptoms recorded were cough (75.2%), vomiting (15.2%), irritability or unexplained crying (7.6%) and dysphagia (1.9%) with the symptom-reflux association of 45.7%, 89%, 71% and 0%, respectively. There were abnormal endoscopic appearance in 52.9%, esophagitis in 64.7% and high reflux score in 47.1%. Video MII-pH study has high diagnostic value with the sensitivity, specificity and accuracy of 72.7%, 100% and 82.4%, respectively.CONCLUSIONPrevalence of GERD in children with EA was high. Video MII-pH study to detect GERD in children with EA had high diagnostic value with the trend of specific symptom association.

Biochemical Manifestations of Gastroesophageal Reflux Disease Progression in Children: A Single Center Case-Control Study

Gastroesophageal reflux disease (GERD) is a common digestive condition, representing one of the most frequent reasons for medical examination, especially in pediatric gastroenterology departments. GERD could be associated with biochemical alterations representing either its systemic manifestations or markers of complications. The aim of our paper was to evaluate biochemical parameters secondary to GERD in children. Two hundred and sixty-seven children of both genders aged between 1 month and 18 years who displayed suggestive symptoms for this condition were included in the study and were monitored for a period of 5 years. Depending on the range of symptoms and technical possibilities, the following procedures/investigations were performed: esophageal pH monitoring and imagistic or endoscopic examination, besides specific biochemical investigations. The cohort was sub-divided into two groups: one that included 213 children with confirmed GERD who represented the study group and 54 healthy children where GERD had been excluded, the control group. Out of all the investigated children, 39.0% displayed low hemoglobin values, 43.7% displayed low values of erythrocyte indices (MCH), and 68.5% had increased erythrocyte sedimentation rate (ESR) values, while increased eosinophil levels were recorded in 46.9% of the cases. Such parameters were proven to be a biomarker of suspected eosinophilic esophagitis, whereas 32.9% of the cases displayed high blood glucose values that could be correlated with gastroesophageal reflux symptoms. Other measured parameters (such as magnesium, aminotransferases and proteins) remained within the normal limits, without statistically significant differences compared to in the control group. This condition is diagnosed based on invasive investigations, which are often difficult to accept by the patients’ parents. The biochemical modifications correlated to the clinical manifestations can anticipate the progression of the disease, thus limiting the necessity of performing invasive diagnosis tests.