Gastroesophageal Reflux In Children Research Articles

24 h combined esophageal multichannel intraluminal impedance and pH monitoring in children with chronic cough

BackgroundChronic cough in children is closely related to gastroesophageal reflux (GER). However, this association has not been adequately studied due to a lack of diagnostic tools. Combined esophageal multichannel intraluminal impedance and pH (MII-pH) monitoring is considered the most accurate method for evaluating the association between symptoms and reflux, but data on its use in children with chronic cough are still lacking. We aimed to assess the association between chronic cough and GER in children through MII-pH monitoring.MethodsChildren with chronic cough (> 4 weeks) who were suspected gastroesophageal reflux disease(GERD) were selected to undergo 24 h MII-pH monitoring at our hospital. Patients were divided into groups according to their age, body position, reflux index (RI) or total reflux events, and the differences between the groups were analyzed. Then the significance and value of 24 h pH and impedance monitoring in chronic cough and the relationship between chronic cough and reflux were discussed.ResultsOverall, 426 patients were included. The median age was 12 months (interquartile range: 6–39.5 months), 129 (30.3%) patients had RI > 7% detected by pH-metry, and 290 (68.1%) patients had positive diagnosis based on the impedance data. GER predominantly occurred in the upright position and mostly involved weakly acidic reflux and mixed gas–liquid reflux. There were 14.1% of children in non-acid GER group were SAP positive showing no difference in acid GER group 13.2% (P = 0.88), whereas patients with SAP > 95% in MII positive group (47[16.2%]) is higher than in MII negative group (P < 0.05).ConclusionTwenty four hour MII-pH monitoring is safe, well tolerated in children, but also has a higher detection rate of gastroesophageal reflux. It can find identify weakly acidic reflux, weakly alkaline reflux and reflux events with different physical properties, which can explain the relationship between GER and chronic cough more comprehensively. It provides new approach for exploring the etiology, diagnosis and treatment of children with chronic cough.

Complex Decision-Making for Gastroesophageal Reflux in Children With Neurologic Impairment.

Complex Decision-Making for Gastroesophageal Reflux in Children With Neurologic Impairment.

Management of Gastro Oesophageal Reflux in children

Management of Gastro Oesophageal Reflux in children

Pharmacological treatment of gastro-oesophageal reflux in children.

Pharmacological treatment of gastro-oesophageal reflux in children.

Gastroesophageal reflux in children with recurrent and chronic respiratory diseases: non-acid or acid?

In some cases, gastroesophageal reflux (GER) may be accompanied by duodenogastric reflux, forming non-acid reflux, which has a certain influence on the clinical presentation and the response to anti-reflux therapy. The study aimed to determine the role of non-acid reflux in children with recurrent and chronic respiratory diseases (RCRD). All children with RCRD, for unknown reason, poorly responding to respiratory-specific therapy, hospitalized for gastroesophageal reflux disease (GERD) screening, using dual pH-multichannel intraluminal impedance (pH-MII). The study was conducted in 42 children at the age Me – 2.75; IQR 1.08-9.42. The most common type of reflux was weakly acid reflux - 62.25 [36.425-121.225], then acid - 34.05 [12.875-71.65], alkaline - 1.75 [0 - 12.375] episodes per day (p &lt;0.05). Non-acid reflux was more common in children with only respiratory symptoms - no esophageal manifestations of GERD. All types of refluxes were more often recorded in the upright compared to the supine position. In 70% patients, cough could be associated with reflux, while in 88% children reflux was non-acid (including 69% - weakly acid, 19% - alkaline), in 38% - acid. Non-acid reflux is the main type of GER in children with RCRD refractory to standard therapy, which could be associated with cough in this patient population.

Adequate timing of diagnostic tests for gastroesophageal reflux in children with esophageal atresia.

Recent guidelines made recommendations for the management of gastroesophageal reflux in patients with esophageal atresia (EA). However, the timing for some diagnostic tests remained somehow unclear. This investigation studied the tests for gastroesophageal reflux in children aged one year old and children aged two or three. Patients with EA who underwent Multichannel Intraluminal Impedance-pH monitoring (MII-pH) and endoscopy-histology were studied retrospectively. Patients aged one when the test was performed were the YO group and patients aged two or three years old formed the OL group. Substantially impaired MII-pH was defined as total number of reflux episodes >105 or >85 (depending on age), or reflux index >10%. Substantially impaired endoscopy was defined as erosive esophagitis or Barrett's esophagus. Substantially impaired histology was defined as moderate-severe esophagitis or Barrett's esophagus. Conventional parameters and substantially impaired values of the tests were compared. Twenty-four patients were studied. Twenty-three MII-pH were performed (12 in YO and 11 in OL): percentages of abnormal conventional parameters of MII-pH were not significantly different in both groups. Twenty endoscopies with biopsies were performed (7 in YO and 13 in OL): percentages of esophagitis were not significantly different. Interestingly, 26.9% of all the tests performed in YO were substantially impaired vs. 10.8% of all the tests in OL (χ2=2.7; p=0.1). Considering the percentage of alarming results of diagnostic tests in the YO group it would be advisable that patients with EA undergo MII-pH and endoscopy-histology at one year of age.

Gastrostomy plus fundoplication or gastro-jejunal tube versus gastrostomy alone for gastro-esophageal reflux in children with neurological impairment

Gastrostomy plus fundoplication or gastro-jejunal tube versus gastrostomy alone for gastro-esophageal reflux in children with neurological impairment

Correlation between cough and gastroesophageal reflux in children

For many decades, the scientific community of medical professionals has wondered if there is a correlation between cough and gastroesophageal reflux. This problem is relevant for doctors of various specialties. The importance of this issue is due to practical application since it determines the tactics of diagnosis and treatment both for cough and gastroesophageal reflux. The article provides an analysis of Russian and foreign literature data, based on which we can conclude that there is a correlation between gastroesophageal reflux (gastroesophageal reflux disease) and cough.

Gastroesophageal Reflux in Children with Asthma.

Background: Nowadays it is considered that a specific causal relationship exists between asthma and gastroesophageal reflux (GER), because of the aspiration of gastric refluate which leads to and maintain spasticity even real crisis of paroxystic expiratory dyspnea. This study explores this relationship and evaluates the results after treatment. Methods: 56 children diagnosed with asthma, hospitalized in a regional center of pediatric gastroenterology in Northeast Romania, underwent 24-hour continuous esophageal pH monitoring in order to establish the presence of GER. The Boix-Ochoa score was used to interpret the results. Proton pump inhibitors were administered to those with GER and the patients were reevaluated after 2 months. Results: 39 patients (69.64%) had GER, with a Boix-Ochoa score above normal (N < 11.99), and 17 patients (30.36%) had normal score. After administering proton pump inhibitors for 2 months, 7 patients still had high Boix-Ochoa score (17.95%). The result of this analysis shows that the presence of asthma increases the chance of GER by 2.86 times. Conclusions: In children with asthma we have to look for GER in order to treat, because it can help the treatment of asthma or even solve some cases resistant to standard treatment.

Childhood gastroesophageal reflux disease with laryngopharyngeal reflux and association of psychosocial risk factors

Childhood gastroesophageal reflux disease with laryngopharyngeal reflux and association of psychosocial risk factors

Evaluation of Gastroesophageal Reflux in Children as a Risk for Post-operative Nausea and Vomiting: An Observational Study.

After obtaining approval from ethics committee, 55 paediatric patients were included. An oesophageal pH metre catheter was inserted through the nasal passage to 3 cm above the lower oesophageal sphincter. pH measurements were evaluated with DeMeester score. It was accepted as acid reflux if the score was >14.7. The patients' demographic data, history of GER and verbal descriptive scale (VDS) to assess PONV and pH values were analysed with Statistical Package for the Social Sciences (SPSS) version 21 (IBM SPSS Corp.; Armonk, NY, USA). Of the 55 patients, 41.8% were girls, 58.2% were boys, the mean age was 13.2 years, the mean fasting period was 7.47 hours and the mean operation time was 1.1 hours. Mean fasting and operation times did not differ statistically according to VDS. There was no significant association between VDS group and gender or pH. None of the patients had a history of GER. Thirteen patients had DeMeester score >14.7. This is the first study about the relationship between gastric pH and PONV in paediatric patients. Although some studies have shown an association between anaesthesia and reflux, we detected reflux in nine of our patients and reflux was not statistically associated with PONV in our study. Further studies with larger patient groups are needed to provide a clearer opinion.

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?

Usefulness of Endoscopic Hill Grade in Evaluating Children Suspected of Having Gastroesophageal Reflux Disease.

Background/AimsThis study aim to evaluate the relationship between the Hill grade confirmed by esophagogastroduodenoscopy (EGD) and the degree of gastroesophageal reflux (GER) by 24-hour multichannel intraluminal impedance-pH monitoring (MII-pH) in children suspected of having gastroesophageal reflux disease (GERD).MethodsA retrospective review of 105 children and adolescents who underwent EGD and MII-pH for the evaluation of GERD from March 2013 to July 2019 was performed. Clinical features and results of EGD and 24-hour MII-pH were collected and statistically analyzed.ResultsHill grades 1, 2, 3, and 4 were identified using EGD in 56 (53.3%), 22 (22.0%), 16 (15.2%), and 11 (10.5%) patients, respectively. As the Hill grade increased, the proportion of neurological diseases (P < 0.001) and endoscopic erosive esophagitis (P < 0.001) increased significantly. The acid exposure index, bolus exposure index, number of reflux episodes, and number of GER reaching proximal extent on MII-pH increased significantly as the endoscopic Hill grade increased (all P < 0.001). Linear regression analysis revealed an increase in the Hill grade by 1 increased the acid exposure index by 2.0%, bolus exposure index by 0.7%, number of reflux episodes by 18.9 episodes, and the number of GER reaching the proximal esophagus increased by 10.5 episodes on average (all P < 0.001).ConclusionsHill grade on EGD was associated with GER in children. Estimating the degree of GER by applying Hill grade in the retroflexion view may be useful in practice when evaluating children suspected with GERD.

The Investigation of Gastroesophageal Reflux in Children with Portal Hypertention

The Investigation of Gastroesophageal Reflux in Children with Portal Hypertention

Risk factors of dumping syndrome after fundoplication for gastroesophageal reflux in children.

In postoperative cases of fundoplication, the gastric emptying ability is promoted and sometimes exhibits dumping syndrome. Dumping syndrome often goes unrecognized in children. Furthermore, the risk factors for postoperative dumping syndrome are unknown. This study aimed to investigate the risk factors of developing dumping syndrome after fundoplication. A retrospective chart review of all consecutive patients between January 2003 and March 2018 (190 patients) who had fundoplication at our clinic was conducted. Regarding the risk factors of dumping syndrome, gender, age and body weight at the time of surgery, neurological impairment, severe scoliosis, microgastria, chromosomal abnormalities, complex cardiac anomalies, gastrostomy, and laparoscopic surgery were retrospectively studied. 17 patients (9%) developed dumping syndrome post-operatively. Multivariate analysis showed that significant risk factors for dumping syndrome included: undergoing surgery within 12months of age (adjusted OR 10.3, 95% CI 2.6-45.2), severe scoliosis (adjusted OR 19.3, 95% CI 4.4-91.1), and microgastria (adjusted OR 26.5, 95% CI 1.4-896.4). We identified that: age at fundoplication being within 12months of age, severe scoliosis, and microgastria were risk factors for dumping syndrome after fundoplication, and that this information should be explaining to the family before conducting the fundoplication.

A Cross-Sectional Study to Determine the Prevalence of Gastroesophageal Reflux in Children with Persistent Cough and Wheezing

Background: Gastroesophageal reflux (GER) occurs in more than two-thirds of otherwise healthy infants and is the topic of discussion with pediatricians at one-quarter of all routine 6-month infant visits. GER is considered a normal physiologic process that occurs several times a day in healthy infants, children, and adults. GER is generally associated with transient relaxations of the lower esophageal sphincter independent of swallowing, which permits gastric contents to enter the esophagus. The Objective to find out the prevalence of GER in children with cough and wheezing and its associated factors. Subjects and Methods: A cross-sectional study was done at A tertiary care hospital at the Institute of Naval Medicine, INHS, Mumbai from August 2016 to December 2017. A total of 30 study subjects Aged between the age of one to twelve years with persistent cough and wheezing lasting for more than three months despite treatment were included for the study. Results: The prevalence of gastroesophageal reflux (GER) in our study was 63.3%.The logistic regression analysis showed that Age, Height, Weight, BMI, duration of cough, Duration of asthma were not significantly associated with Gastroesophageal reflux (GER) (p&gt;0.05). Conclusion: GER seems to have a high prevalence in children with chronic cough. However, no definite recommendations can be made regarding the management of such cases from our study.

Surgical Interventions for Infant and Childhood Gastroesophageal Reflux Disease

Gastroesophageal reflux (GER) is a common condition in infants, thought to be the result of transient lower esophageal sphincter relaxations which occur independent of swallowing.&nbsp; Most cases of GER are physiologic and generally resolve by early childhood. Gastroesophageal reflux disease (GERD) is diagnosed when symptoms persist or complications such as aspiration or esophagitis develop.&nbsp; Currently there is wide practice variation in the surgical treatment of severe infant and childhood reflux with multiple acceptable surgical approaches chosen based on individual disease characteristics as well as surgeon preference.&nbsp; In this review article we discuss the use of laparoscopic fundoplication, gastrojejunostomy and jejunostomy tube placement to mitigate the symptoms of GERD. &nbsp;Although these minimally invasive techniques have greatly advanced treatment in infants and children, a paucity of data exists comparing outcomes of each technique, resulting in a lack of consensus on best technique.&nbsp; Surgical approach to GERD treatment is an important area of research that needs further investigation.

DOZ047.60: Evaluation of gastroesophageal reflux in children born with esophageal atresia using pH and impedance monitoring

Abstract Aim of the Study The ESPHGAN-NASPGHAN guideline (Krishnan, 2016) recommends routine prescription of proton pump inhibitors in the first year of life after esophageal atresia (EA) repair, and to monitor gastroesophageal reflux (GER) using pH-impedance (pH-MII) monitoring and/or endoscopy at time of discontinuation and during long term follow up of these patients. This study aimed to evaluate acid and non-acid GER in infants and school-aged children with EA using pH-MII monitoring. Methods Children born with EA between 2011–2017, who underwent a 24-hour pH-MII study during infancy (≤18 months) or at 8 years old as part of a standardized longitudinal follow-up program, were included. Exclusion criteria were: isolated tracheoesophageal fistula, esophageal replacement therapy, tube feeding and monitoring &lt; 18 hours. Anti-acid therapy was discontinued before pH-MII measurement. Data was collected on reflux index (RI; exposure to pH &lt; 4 in %, &gt;7% considered abnormal), retrograde bolus movements (RBM) and bolus clearance time (BCT). Automatically detected RBM were manually reviewed and modified/deleted if necessary. Results We included 57 children (51% male, 2% isolated EA, 44% thoracoscopic repair): 24 infants (median age 0.6 years) and 33 school-aged children (median age 8.2 years). In infants, median RI was 2.6% (abnormal in n = 2), median RBM was 61 (62% non-acid, 58% mixed) and median of the mean BCT was 11 seconds. In school-aged children, median RI was 0.3% (abnormal in n = 4), median RBM was 21 (64% non-acid, 75% mixed) and median of the mean BCT was 13 seconds. Of the automatically detected 3,313 RBM, 1,292 were manually deleted from the tracings: 52% of non-acid RBM and 8% of acid RBM (mainly misinterpreted swallows or one event recognized as several events). Conclusions Most children with EA off medication have a normal RI, yet experience a significant number of non-acid RBM. After manual revision of the tracings a high percentage of RBM was deleted. Our data show that automated impedance analysis software needs refinement for use in infants and children with EA, and question the need for standard anti-acid therapy in these patients.

Pulmonary infection complicated with gastroesophageal reflux in children: Influential factors and clinical features

Pulmonary infection complicated with gastroesophageal reflux in children: Influential factors and clinical features