Disease In Pediatric Population Research Articles

Noninvasive Evaluations of Non-alcoholic Fatty Liver Disease in Pediatric Populations

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Dermatological findings in common rheumatologic diseases in children

The aim of this study is to outline the common dermatological findings in pediatric rheumatologic diseases. A total of 45 patients, nineteen with juvenile idiopathic arthritis (JIA), eight with Familial Mediterranean Fever (FMF), six with scleroderma (SSc), seven with systemic lupus erythematosus (SLE), and five with dermatomyositis (DM) were included. Control group for JIA consisted of randomly chosen 19 healthy subjects of the same age and gender. The age, sex, duration of disease, site and type of lesions on skin, nails and scalp and systemic drug use were recorded. χ2 test was used. The most common skin findings in patients with psoriatic JIA were flexural psoriatic lesions, the most common nail findings were periungual desquamation and distal onycholysis, while the most common scalp findings were erythema and scaling. The most common skin finding in patients with oligoarthritis was photosensitivity, while the most common nail finding was periungual erythema, and the most common scalp findings were erythema and scaling. We saw urticarial rash, dermatographism, nail pitting and telogen effluvium in one patient with systemic arthritis; and photosensitivity, livedo reticularis and periungual erythema in another patient with RF-negative polyarthritis. Vascular skin lesions like RaynaudÂ’s phenomenon, livedo reticularis, palmar erythema, periungual telangiectasia and nailfold abnormalities were common in SLE, DM and SSc. Patients with FMF displayed signs of atopy. Specific skin lesions can be the peculiar features of rheumatologic diseases in pediatric population. Since it is not always easy to perform biopsy in children to confirm skin involvement of a rheumatologic disease, skin findings can help both dermatologists and rheumatologists in diagnosis.

Advances in diagnosis of chronic liver diseases in pediatric patients.

Chronic liver diseases (CLD) present important clinical problem in children with various age-dependent causes. Nonalcoholic fatty liver disease (NAFLD) with its increasing prevalence is a major problem with regard to its timely recognition and the need for long-term disease monitoring. At present, a perfect non-invasive method for the evaluation of liver fibrosis is not available. A non-systematic literature search was performed to summarize the current knowledge about transient elastography (TE) with controlled attenuation parameter (CAP) in children with CLD. Ovid MEDLINE, Ovid EMBASE, Google scholar, and The Cochrane Library databases were searched for relevant articles evaluating TE in the pediatric population. Normal values of liver stiffness measurements (LSM) according to the age are given, as well as the advantages and disadvantages of the method. The utility of TE in specific liver disease in pediatric population is summarized. TE with CAP is a valuable non-invasive method for the liver-damage assessment. Clinical interpretation of TE results should be made in parallel with the assessment of the patient's demographics, disease etiology, and essential laboratory parameters.

REGISTRIES AND CARE OF NEUROMUSCULAR DISORDERS: P.294Muscle biopsy in the study of muscle disease in pediatric population

REGISTRIES AND CARE OF NEUROMUSCULAR DISORDERS: P.294Muscle biopsy in the study of muscle disease in pediatric population

Clostridium difficile. Susceptibility profiles to Vancomycin and Metronidazol in a pediatric population.

Background: There has been an increase in incidence and morbi-mortality of Clostridium difficile infection (CDI) in the last few years and even though it was considered a low risk disease in pediatric population it has become an emerging problem. The objective of this study was to evaluate the susceptibility of C. difficile isolates to the antimicrobial drugs of choice from patients with CDI in an Argentinean Pediatric Hospital Methods & Materials: Retrospective study. From January 1, 2014, through September 30, 2017, 5686 stool samples (SS) were analyzed to detect C. difficile toxins A and B (tAB). Those that tested positive were cultured in order to isolate C. difficile to conduct in-vitro susceptibility testing. Minimal Inhibitory Concentration (MIC) values were determined for Metronidazol (MTZ) and Vancomycin (VAN) using the epsilometer test method (E-test). The breakpoints established by the Clinical and Laboratory Standards Institute (CLSI M100-S27 Document) and the European Committee of Antimicrobial Susceptibility Testing (EUCAST - Version 7.0) were used to analyze the results. Results: Among all 5686 SS only 119 (2%) tested positive for tAB and 89 C. difficile were isolated. The MIC50 and MIC90 of MTZ were 0.032 and 0.064 μg/ml, respectively. The MIC50 and MIC90 of VAN were 0.5 and 1 μg/ml, respectively. Conclusion: According to CLSI breakpoints all the Hospital isolates of C. difficile were susceptible to MTZ. As there are no CLSI breakpoints for VAN we considered EUCAST breakpoints which are based on epidemiological cut-off values. This allowed us to distinguish wild types isolates (MIC ≤ 2 μg/ml) from those with reduced susceptibility (>2 μg/ml). All isolates behaved as wild types. We found no discrepancies between our experience in this study and previous reports regarding C. difficile susceptibility to the these antimicrobial agents.

Are there any new reliable markers to detect renal injury in obese children?

Aim: The aim of this study was to examine the serum and urine levels of kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), osteopontin (OPN), matrix metalloproteinase-9 (MMP-9), and serum Cystatin-C to determine the renal effect of obesity in obese children. Methods: Seventy-two obese and 35 non-obese healthy children were included in this study. Blood pressure (BP) was evaluated with office measurement. Creatinine, cystatin C, lipids, fasting glucose, and insulin levels were measured, and homeostasis model assessment -insulin resistance (HOMA-IR) was calculated. The urine albumin/creatinine ratio was calculated. The serum and urine KIM-1, NGAL, OPN, and MMP-9 levels were measured. Results: Serum cystatin-C, triglyceride, and homeostasis model assessment-insulin resistance (HOMA-IR) index were found to be significantly higher in the obese group (p = .0001), and high-density lipoprotein (HDL) cholesterol was found to be significantly lower (p = .019) in the obese group. No significant differences were found in serum KIM-1, NGAL, OPN or MMP-9 levels between groups (p > .05). No significant differences were found in urine KIM-1 and MMP-9 levels (p > .05), Urine NGAL, and OPN levels were found significantly higher in obese groups (p < .05). Conclusions: According to our results, although serum KIM-1, NGAL, OPN, MMP-9, and urine MMP-9, urine KIM-1 do not appear to be ideal markers to evaluate renal injury in the early period of obesity, the serum levels of cystatin C and urine NGAL, urine OPN can be used as a good marker for assessing the renal effect of obesity which can lead end stage renal disease in pediatric population.

Technical feasibility, radiation dosimetry and clinical use of 18F-sodium fluoride (NaF) in evaluation of metastatic bone disease in pediatric population.

The role of 18F-fluoride (18F-NaF) PET-CT for the detection of bone metastases in adults is well established and is considered superior to conventional bone scintigraphy. However, data pertaining use of 18F-NaF PET-CT in pediatric oncology is relatively sparse. The aim of the present study is to retrospectively analyze and share a single-center experience of 18F-NaF PET-CT in pediatric population and to provide preliminary information regarding imaging technique, feasibility of this modality in young patients and radiation dosimetry measurements in pediatric oncology cases. Twenty-four pediatric patients (mean age 8.0 ± 3.9) were included in the study for retrospective analysis. All patients were referred for primary staging or restaging for potential osseous metastatic disease and PET-CT scan was performed by injecting 2.2MBq/kg (0.06mCi/kg) of 18F-NaF. Nine patients were imaged for primary staging and in all cases increase osteoblastic activity was seen in the primary tumor and of these, metastatic bone disease was identified in 2/9 patients. In the restaging group comprising 15/24 patients, metastatic deposits were identified in 3/15 whilst no disease was seen in the remaining 12 patients. Patients were injected a mean dose of 90.35 ± 22.9MBq with an estimated mean effective absorbed doses of 2.98 ± 0.75mSv for 18F-NaF and 3.37 ± 2.4mSv for CT alone. Mean cumulative effective dose of 18F-NaF PET-CT scan was 5.11 ± 2.7mSv. 18F-NaF PET-CT may be a feasible alternative to 99mTc MDP for radionuclide bone scintigraphy in the evaluation of pediatric bone pathology. Due to its better pharmacokinetics, there is potential that osseous staging can be achieved with relatively low doses and with a similar radiation burden as with 99mTc-MDP imaging.

DIAGNOSTIC AND TREATMENT OF BRONCHIAL ASTHMA IN CHILDREN OF PRESCHOOL AGE. PLACE OF NEBULIZED INHALED GLUCOCORTICOSTEROIDS IN TREATMENT OF BRONCHIAL ASTHMA AND CROUP (CONSENSUS ON THE RESULTS OF THE COUNCIL OF EXPERTS OF THE PEDIATRIC RESPIRATORY SOCIETY)

Although bronchial asthma is a widespread disease in pediatric population, physicians still face difficulties in early diagnostics of bronchial asthma in preschool children due to a high frequency of bronchial obstruction in this age group. This article covers key points of the resolution adopted by the Panel of Experts of Pediatric Respiratory Society regarding standardization of the approach to diagnostics and therapy of broncho-obstructive conditions, considering a cause of the disease, child’s age and condition severity, as well as a place of nebulized budesonide suspension in maintenance treatment of bronchial asthma and acute exacerbations therapy.

Seasonal variation of pediatric dermatoses: a retrospective study conducted in tertiary care centre Ujjain

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Skin diseases in pediatric age are common health problem with wide variation in the presentation in various regions. Association of seasonal variation in skin disease has been studied for centuries. Environmental factors plays significant role in skin disease. Different climatic factors that may decide the incidence of skin diseases. Cold, warmth, light and humidity play direct or indirect role in occurrence of various dermatosis. Many studies have been done to study pattern of skin disease in pediatric population but only few studies are done for its clinical correlation of seasonal variation. Hence we decided to study seasonal variation in pediatric dermatoses. The objective of the study was to study the seasonal variation, age-wise variation and distribution of common dermatoses in pediatric population in 0-15 years.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a retrospective study done in R.D. Gardi Medical College, Ujjain over a period of one year. A total of 1110 cases of age 0-15 years, who presented in out-patient clinic of dermatology deparment were included in this study. Demographic profile and clinical details were recorded. Data were collected and patient’s details were categorized according to four seasons summer, autumn, winter and spring. Microsoft excel was used for data entry and analysis was done using SPSS version 22.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of all the subjects recruited, 55.7% were males and 44.3% were females with M:F ratio1.25:1. The maximum numbers of patients were in the age group of 10-15 years (43.3%). Majority of visits were in summer (n=360, 32.43%) followed by winter and spring season. Most common dermatosis seen during summer was bacterial infection (n=93, 8.37%) and during winter was eczema (n=62, 5.58%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Dermatoses in children are wide spread problem responsible for significant morbidity in them. In the present study there is seasonal variation of dermatological diseases in pediatric age group. &lt;/p&gt;

The Prevalence of Asthma in Children with Type 1 Diabetes Mellitus and Relationship between Control of Diabetes and Severity of Asthma

Background: Type 1 diabetes mellitus (T1DM) is by far the most common metabolic disease in children. Asthma is the most common chronic disease in pediatric population, and its prevalence has increased in the last decades. In this study, the prevalence of asthma among these children with T1DM has been described and its association with the demographic and clinical characteristics of Iranian children has been evaluated. Materials and Methods: A cross sectional study was carried out on children with T1DM who referred to pediatric endocrinology clinics of Isfahan University of Medical Sciences. The participants were classii¬�ed as a group with asthma and the second group as diabetic children without asthma. After selection and evaluation of the diabetic patients with asthma, their glycemic status was evaluated three times in the past year. All data were analyzed using the SPSS version 23.0 statistical software package. Results: A total of 419 patients (49.4 male and 50.6 female) diagnosed with T1DM were included in the study. The mean age of patients at the time of recruitment was 12.65 ± 3.9 years with a range from 3.8 to 18 years. The mean of disease duration was 5.3 ± 2.7 years. Among all participants, asthma was detected in 24 children with T1DM (5.7). Glycemic control was significantly poorer among asthmatic patients with diabetes compared with diabetic patients without asthma. Conclusion: The study demonstrated a lower prevalence of asthma among T1DM children rather healthy ones. Hence, diabetic child patients with asthma experience poorer glycemic control in comparison with T1DM patients without asthma.

Imatinib in the treatment of chronic myeloid leukemia in children and adolescents is effective and well tolerated: Report of the Polish Pediatric Study Group for the Treatment of Leukemias and Lymphomas.

Chronic myeloid leukemia (CML) constitutes only 2-3% of all leukemias in pediatric patients. Philapelphia chromosome and BCR-ABL fusion are genetic hallmarks of CML, and their presence is crucial for targeted molecular therapy with tyrosine kinase inhibitors (TKIs), which replaced hematopoietic stem cell transplantation (HSCT) as a standard first-line therapy. The disease in pediatric population is rare, and despite molecular and clinical similarities to CML in adults, different approach is needed, due to the long lifetime expectancy and distinct developmental characteristics of affected children. The objective of this study is to evaluate treatment with imatinib in Polish pediatric patients with CML. We analyzed the results of treatment with imatinib in 57 pediatric patients (June 2006 - January 2016) from 14 Polish pediatric hematology and oncology centers. In the study group, 40 patients continued imatinib (median follow-up: 23.4 months), while in 17 the treatment was terminated (median follow-up: 15.1 months) due to therapy failure. In the latter group, 13 patients underwent HSCT, while 4 switched to second-generation TKIs. The 5-year overall survival rate (OS) in the study group was 96%, and the 5-year event-free survival (EFS) was 81%. Our results confirm that the introduction of TKI therapy has revolutionized the treatment of CML in the pediatric population by replacing the previous method of treatment with HSCT and allowing a high percentage of OS and EFS.

Pedijatrijsko radioterapijsko odeljenje - preporuke za optimalnu infrastrukturu i kadar

In multidisciplinary treatment of malignant diseases in pediatric population, radiotherapy with or without surgery, represents the basic modality of local treatment. Although the basic principles of radiotherapy in children are the same as in adults, it has its own specificity because it is applied to an organism in the phase of growth and development. Also, pediatric tumors differ from tumors in adults, so pediatric radiation oncologist has to have knowledge of pediatric oncology. Treatment of children with malignant diseases requires coordinated work of a multidisciplinary team: radiation oncologist, pediatrician, various specialty surgeons, pathologists, each of whom participates in the decision making on combined oncological treatment. Treatment decisions are necessary made in a multidisciplinary environment with the necessary knowledge of all members of the pediatric oncology team. Pediatric radiation oncology has its specifics and requirements in terms of infrastructure and organization. The basic requirements apply to rooms, equipment, staff, and procedures. Based on the international recommendations, the necessary radiotherapy equipment and its number, for the work with children, is defined. In the treatment of children it is recommended to use 3D conformal radiotherapy, or other advanced techniques, in order to avoid the irradiation of healthy tissues as much as possible. Monitoring early and late unwanted effects of radiotherapy is of great importance in treating children with malignant tumors. Also, a certain level of knowledge in the pathology of malignant diseases of children is necessary of all the members of radiotherapy team. Pediatric radiotherapy, as an extremely sophisticated and complex method of treatment, can therefore only be performed in hospitals and centers that can meet all of the above high standards and recommendations with the coordinated work of a multidisciplinary team with experience in pediatric oncology.

Role of single and mixed probiotics in acute diarrheal diseases in pediatric population

Background: The objective of present study was to analyse the effect of probiotics on various parameters of acute diarrhoeal disease and to compare single and mixed probiotic preparations in context to their role in acute diarrhoeal disease in paediatric population.Methods: A double blind controlled trial was conducted in children suffering from acute diarrhoeal disease at department of paediatrics jointly with department of pharmacology, G. S. V. M. Medical college, Kanpur, U.P., India. All enrolled children were divided into three groups having similar baseline characteristics. One group was given single probiotic preparation another mixed probiotic preparation and the third one (i.e. control group) placebo plus Zinc/ORS to all three groups. Various parameters such as frequency and consistency of stool, duration of diarrhoea were measured after doing intervention over a period of one week.Results: In our study duration of diarrhoea, stool frequency and total duration of hospital stay was found significantly less in probiotic groups compared to control group. However no significant difference was found between single and mixed probiotics in curtailing the acute diarrhoeal illness.Conclusions: Probiotics should be used judiciously in acute diarrhoeal diseases. There is no additional benefit of mixed probiotics in acute diarrhoeal diseases rather than increasing the cost of treatment.

Pattern of Corneal Diseases in Paediatric Age Group at a Tertiary Eye Care Center in Nepal.

It is to study the pattern of corneal diseases (including injuries) in paediatric population in a tertiary eye care center. A descriptive, cross sectional study was carried out in a tertiary eye care center which included 176 cases. Out of 176 cases studied, 6 cases (3.4%) presented with congenital causes, 4 cases (2.27%) were of dystrophy and ectasia, 63 cases (35.79%) had infective origin, 17 cases (9.65%) had inflammatory cause, 9 cases (5.11%) had systemic association and 77 cases (43.75%) had traumatic causes. Trauma was noted to be the most important cause for corneal diseases in paediatric population followed by infective conditions. Viral keratitis was found to be the most common type of corneal infection in the paediatric age group.

A study of dermatoses in patients attending pediatric OPD in a tertiary care hospital of Gandhinagar, Gujarat, India

Background: Skin diseases in paediatric population are common all over the world. There is a wide variation in the presentation of Dermatoses in various studies. The variation among dermatoses can possibly be due to region of study, prevalent environmental factors, type of population studied, and hygiene and nutritional status and environmental factors. The objective of this study was to study prevalence, pattern of presentation and aetiologies of various dermatoses in paediatrics.Methods: A prospective, observational, single center study involving 500 patients of Dermatoses was carried out in a pediatric outpatient department. Detailed history, clinical presentation and other relevant parameter were recorded in a case record form and analyzed.Results: Majority of patients with dermatoses (39.40%) belong to age group of 6 - 16 years with male preponderance. Etiological analysis showed infections and infestations were most common dermatoses. Bacterial infection (184, 36.80%) was most common followed by viral (87, 17.40%), parasitic (51, 10.20%) and fungal (25, 5.00%) infection. Dermatitis was present in 30.6% patients. Diaper dermatitis (19 patients) was the commonest dermatitis present in infants while eczema and urticaria were the commonest dermatitis in school going children. Pyoderma was the commonest dermatoses in this study, present in 111 patients (22.20%) followed by varicella (14.40%), impetigo (12.80%); scabies (10.20%), eczema (10.20%) and urticaria (7.60%).Conclusions: Dermatoses in children are a wide spread problem which are responsible for significant morbidity in children. The high incidence of infections and infestations are possibly due to poverty, overcrowding, undernutrition, poor hygiene and lack of health education. Skin of the young children is more prone to develop skin disease.

Multimodality imaging of pediatric airways disease: indication and technique.

Congenital and acquired airway anomalies represent a relatively common albeit diagnostic and therapeutic challenge, even for the most skilled operators in dedicated centers. Airway malformations encompass a wide spectrum of pathologies involving the larynx, trachea and bronchi, esophagus, mediastinal vessels. These developmental lesions are often isolated but the association of two or more anomalies is not infrequent. From the traditional chest X-ray to the newest applications of Optical Coherence Tomography, non- or mini-invasive diagnostic techniques represent useful tools to integrate invasive procedures. Comprehensive knowledge of the characteristics of each diagnostic test is mandatory for its useful application. The aim of our paper is to analyze the clinical indications for Imaging the Airway disease in pediatric population, and describe the diagnostic techniques. Only by a close interaction between all the operators involved in diagnosis and treatment of pediatric airway, as it happens in Multidisciplinary Airway Team, the non- or mini-invasive imaging is effective.

Prevalence of Oral Diseases in Pediatric Population in Karachi, Pakistan-A Cross-Sectional Survey

Prevalence of Oral Diseases in Pediatric Population in Karachi, Pakistan-A Cross-Sectional Survey

Spectrum of Celiac disease in Paediatric population: Experience of Tertiary Care Center from Pakistan.

Objective:To determine clinical features and relevant laboratory investigations of patient with celiac disease (CD) and comparing classical celiac disease (CCD) with Non-diarrheal celiac disease (NDCD).Methods:This is a five years retrospective study conducted at The Aga Khan University Hospital Karachi, Pakistan from January 2010 to December 2015, enrolling children from one year to 15 years of either gender diagnosed as celiac disease in accordance with revised ESPGHAN criteria. Biopsy samples with grade 2 or more on Modified Marsh Classification were considered as consistent with celiac disease. Celiac patients were categorized into Classical celiac disease (with Chronic Diarrhea) and non-diarrheal celiac disease (Atypical celiac) and their clinical features and relevant laboratory investigations were documented.Results:Total 66 patients were selected with celiac disease according to inclusion criteria, 39 (59.09%) patients were labeled as CCD and 27 (40.91%) patients were labeled as NDCD. Marsh grading 3a and above were more marked in CCD as compared to NDCD. Mean titer for Tissue transglutaminase antibodies (TTG) were higher in CCD group in comparison to NDCD group. In CCD, the most common clinical presentations were abdominal distension whereas in NDCD, the most remarkable features were recurrent abdominal pain (62.9%). Frequency of failure to thrive is significantly high in CCD (82.05%) but patients merely with short stature were more common in NDCD (33.3%). Refractory anemia was present in 66.6% patients in NDCD group and 41.1% patients in CCD group. 74.3% patients in CCD group were vitamin D deficient whereas 85% patient had vitamin D deficiency in NDCD group (p= 0.03).Conclusion:NDCD is not uncommon in our population. Recurrent abdominal pain, failure to thrive or patients only with short stature and refractory anemia are prominent features in NCDC group whereas abdominal distension, failure to thrive and recurrent abdominal pain were noticeable features in CCD. High grade histopathology and raised antibodies titer is hallmark of CCD. Vitamin D deficiency is almost equally present in both groups.

Physical activity versus metformin for increasing insulin sensitivity in children and adolescents at-risk for type 2 diabetes

Global rates of type 2 diabetes (T2D) among children and adolescents are steadily rising. As such, an increasing amount of attention and research has begun to focus on strategies to prevent this chronic and burdensome disease in pediatric populations. The purpose of this article is to briefly review current evidence pertaining to the effectiveness of physical activity versus metformin in improving insulin sensitivity of children at-risk (ie, obese and/or insulin resistant) for developing T2D. Potential barriers to each preventative intervention will also be discussed. Physical activity, both aerobic and resistance, has demonstrated effectiveness in a moderate number of demographically diverse pediatric studies. However, the pediatric population is already alarmingly sedentary with barriers such as lack of motivation, social stigma and discomfort presenting a challenge. A small number of studies have demonstrated the beneficial effects of metformin in children and adolescents for improved insulin sensitivity. However, longer and larger studies are required to confirm these findings and elucidate upon the long-term safety and efficacy of this pharmaceutical in pediatric populations. While no head-to-head studies examining physical activity and metformin exist in pediatric populations and more research is needed, current evidence seems to favour the use of physical activity given the larger quantity of studies and generalizability of its beneficial effects. Thus, physical activity should be emphasized in clinical and public health practice when targeting at-risk children and adolescents to prevent a T2D diagnosis.

Patterns of reflux in gastroesophageal reflux disease in pediatric population of New South Wales.

This study is to determine the association of ambulatory pH monitoring (24hr pH) with symptoms of gastroesophageal reflux and its other investigations. The clinical and epidemiological profiles of subjects referred for reflux disorders are also studied. Symptoms or group of symptoms, profiles and prior investigations of 1259 consecutive pediatric subjects (with 1332 24hr pH studies performed) referred for evaluation of reflux disorders between 1988 and 2012 were retrospectively studied. Chi-square or fisher exact test was used for hypothesis testing, student t-test for the comparison of means and the Wilcoxon rank-sum test for comparing medians of continuous variables. Gastroesophageal reflux disease (GERD), defined as reflux causing major symptoms and complications, was diagnosed in 57.5% subjects of the total sample. Forty-three percent were girls and 56.7% were boys. The most common age group was between 4months and 2years (51.2%). Vomiting (64.4%) and irritability (74%) were the most common symptoms with the neurological conditions (23.2%) being the most frequent underlying condition. The parameters used in 24hr pH were significantly higher in those diagnosed with GERD (P < 0.0001). The prevalence of GERD was found to be significantly higher when both gastrointestinal and respiratory symptoms were present (P = 0.008) at 66.4% than when compared with gastrointestinal (56.5%) and respiratory (52.2%) symptoms in isolation. Symptoms alone were not reliable in diagnosing GERD. Only 57.5% had GERD among patients referred for reflux disorders. 24hr pH is reliable and should be considered routine in reflux disorders, as it identifies patients with pathologic reflux and avoids a needless surgery.