Suspicion Of Gastroesophageal Reflux Disease Research Articles

Comparison of daytime and nighttime supine gastroesophageal reflux by pH monitoring of individuals with clinical suspicion of gastroesophageal reflux disease.

This study aims to compare pHmetric characteristics of diurnal and nocturnal supine reflux. We studied 500 consecutive individuals with clinical suspicion of gastroesophageal reflux disease (GERD) who underwent esophageal high-resolution manometry and prolonged ambulatory pH monitoring. Patients were classified with supine GERD pattern when the percentage of acid reflux time in the supine position was equal to or greater than 2.2%. Data on acid reflux in the supine position during daytime and nighttime recumbency were: (i) acid exposure time, (ii) number of reflux episodes, (iii) longest reflux episode, (iv) interval between the last meal and the supine position, (v) interval between the supine position and the first acid reflux episode, and (vi) reported symptoms. Of the 500 evaluated patients, 238 (48%) had GERD. Among these, supine pattern was observed in 134 (56%) patients, bipositional in 53 (23%), and orthostatic in 51 (21%). In patients with daytime recumbency, 112 (51% of 217) were pathological refluxers, with a mean DeMeester score of 45 ± 26. Total acid exposure time (P = 0.8) and reported Symptom Index (P = 0.2) did not differ depending on the period, whether diurnal or nocturnal. All other pHmetric parameters were lower during daytime recumbency. In conclusion, diurnal supine reflux has similar acid exposure time and temporal correlation between symptoms and reflux episodes as nocturnal supine reflux. Other pHmetric parameters are lower for diurnal supine reflux.

Regional differences in the use of proton pump inhibitors in children

Physiological gastroesophageal reflux in infancy is difficult to distinguish from reflux disease. International guidelines recommend restrictive use of acid suppression therapy for infants due to the lack of documented effect, but its use in infants and older children has increased in recent years. This study aims to describe change over time and geographic variation in the investigation and treatment of suspected gastroesophageal reflux disease. In aggregated data from the Norwegian Prescribed Drug Registry for the period 1.1.2007-31.12.2020, we examined regional differences in the number of proton pump inhibitors dispensed for children and adolescents. Data from the Norwegian Patient Registry were analysed to identify the use of 24-hour pH measurement and gastroscopy, which can support the suspicion of gastroesophageal reflux disease. The number of proton pump inhibitors dispensed in the first year of life increased and was highest in South-Eastern Norway Regional Health Authority, with 10.1 per 1000 children in 2007 and 54.7 per 1000 children in 2020 (relative risk 5.4, 95% confidence interval 4.6 to 6.4). The number dispensed in 2020 was 64% higher in South-Eastern Norway Regional Health Authority compared to Northern Norway Regional Health Authority and Central Norway Regional Health Authority. There was little change in the number of gastroscopies, but use of 24-hour pH measurement fell by 52% from 2016 to 2020. Use of proton pump inhibitors in infants has increased considerably despite the guidelines. Together with geographic variation, this may point towards overtreatment of physiological reflux in infants. Few investigations indicate that an increasing proportion are treated without supporting diagnostics.

LUNCH—Lung Ultrasound for early detection of silent and apparent aspiratioN in infants and young CHildren with cerebral palsy and other developmental disabilities: study protocol of a randomized controlled trial

BackgroundChildren with neurological impairment may have dysphagia and/or gastro-esophageal reflux disease (GERD), which predispose to complications affecting the airways, increasing risk for aspiration-induced acute and chronic lung disease, or secondarily malnutrition, further neurodevelopmental disturbances, stressful interactions with their caregivers and chronic pain. Only multidisciplinary clinical feeding evaluation and empirical trials are applied to provide support to the management of feeding difficulties related to dysphagia or GERD, but no standardized feeding or behavioral measure exists at any age to assess aspiration risk and support the indication to perform a videofluoroscopic swallowing study (VFSS) or a fibre-optic endoscopic examination of swallowing (FEES), in particular in newborns and infants with neurological impairments. Lung ultrasound (LUS) has been proposed as a non-invasive, radiation-free tool for the diagnosis of pulmonary conditions in infants, with high sensitivity and specificity.MethodsA RCT will be conducted in infants aged between 0 and 6 years having, or being at risk for, cerebral palsy, or other neurodevelopmental disease that determines abnormal muscular tone or motor developmental delay assessed by a quantitative scale for infants or if there is the suspicion of GERD or dysphagia based on clinical symptoms. Infants will be allocated in one of 2 groups: 1) LUS-monitored management (LUS-m); 2) Standard care management (SC-m) and after baseline assessment (T0), both groups will undergo an experimental 6-months follow-up. In the first 3 months, infants will be evaluated a minimum of 1 time per month, in-hospital, for a total of 3 LUS-monitored meal evaluations. Primary and secondary endpoint measures will be collected at 3 and 6 months.DiscussionThis paper describes the study protocol consisting of a RCT with two main objectives: (1) to evaluate the benefits of the use of LUS for monitoring silent and apparent aspiration in the management of dysphagia and its impact on pulmonary illness and growth and (2) to investigate the impact of the LUS management on blood sample and bone metabolism, pain and interaction with caregivers.Trial registrationTrial registration date 02/05/2020; ClinicalTrials.gov Identifier: NCT04253951.

Low Mean Nocturnal Baseline Impedance is Associated With a Pathological Acid Exposure Time in Children.

The baseline impedance (BI) and the mean nocturnal baseline impedance (MNBI) serve as markers of mucosal integrity in patients with pathologic acid exposure time (AET). This work aims to investigate the association between the BI and MNBI with the AET in children. A retrospective study was performed in children ≤18 years old with suspicion of gastroesophageal reflux disease who underwent both endoscopy and pH-impedance monitoring (pH-MII). Esophagitis was graded according to the Los Angeles classification. The pathological AET was determined depending on the age (≥5% in patients >1 year and ≥10% in those ages ≤1 year). For the BI, 60 s measurements were taken every 4 h, and for the MNBI, 3 10 min measurements were taken between 1.00 and 3:00 am; then, they were averaged. The means of BI and MNBI were compared with each other, with the AET, and other variables. Sixty-eight patients were included, 25% of patients presented pathological AET. The mean of the MNBI was higher than BI in channels 6 (2195 vs 1997 Ω, P = 0.011) and 5 (2393 vs 2228 Ω, P = 0.013). BI and MNBI at channel 6 were lower in patients with pathological AET than in those with normal AET (1573 vs 2138 Ω, P = 0.007) and (1592 vs 2396 Ω, P = 0.004), respectively. Children with pathological AET had lower impedance values than those with normal AET. BI and MNBI measurements should be part of the routine MII-pH assessment in children.

Importance of esophageal pH monitoring and manometry in indicating surgical treatment of gastroesophageal reflux disease.

To demonstrate the need of performing esophageal pH monitoring and manometry in patients with clinical suspicion of Gastroesophageal reflux disease, as more accurate and practical complementary exams in the indication of surgical treatment. A systematic review was carried out in the PubMed/Medline database, based on the recommendations of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol, selecting studies in humans, published in Portuguese, Spanish, and English, from January 1, 2009 to August 5, 2020. The following descriptors were used: "reflux gastroesophageal" AND "surgery" AND "surgical treatment" AND "esophageal manometry" OR "pH monitoring". After that, retrospective or prospective observational studies with a sample of less than 100 individuals, or with limited access, reports or case series, review articles, letters, comments, or book chapters were excluded. To facilitate the application of the exclusion criteria, the Rayyan management base was used. Out of the 676 studies found, 19 valid and eligible studies were selected to make inferences. Based on the best evidence, currently, considering national particularities, performing a 24-hour esophageal pH monitoring and esophageal manometry for all patients undergoing anti-reflux surgery.

Clinical Management of Children with Oropharyngeal Aspiration - Physician Survey.

Introduction: Pulmonary aspiration in infants and children is common, with 25% of the pediatric population reported to experience some type of nonspecific swallowing dysfunction. Diagnosing and managing oropharyngeal aspiration remain a challenging task due to the lack of distinguishing clinical or laboratory characteristics. We conducted a large, physician-based survey in an effort to determine the differences in the diagnosis and management of patients with oropharyngeal aspiration across different centers, using a quantitative online questionnaire. Methods: A survey was developed with the goal of understanding the physician demographics, diagnosis, management strategies, and the role of specialized centers for airway, voice, and swallowing disorders (also known as Aerodigestive Disease Centers). The questionnaire was sent to the pediatric membership of the American Thoracic Society. Results: A total of 136 questionnaires were completed and physicians from 42 different Aerodigestive Digestive Centers participated in the survey. Ninety-two percent of respondents believed that the evidence is unclear on the best methods for diagnosing lung disease related to oropharyngeal aspiration. Modified barium swallow (MBS) study and fiberoptic endoscopic evaluation of swallowing were the most useful studies in making the diagnosis of the oropharyngeal aspiration according to the participants. The majority of the participants preferred to repeat the feeding evaluations and MBS after the initial intervention. For children with suspected or confirmed aspiration, 68.6% of the respondents stated that they combine endoscopy and flexible and/or rigid bronchoscopy for further evaluation, while 27.1% preferred to perform the procedures individually at the discretion of each specialty provider. Inhaled corticosteroids were mostly prescribed if there was any component of bronchial hyperreactivity, and acid suppression therapy was primarily prescribed if there was a diagnosis or suspicion of gastroesophageal reflux disease. Empirical thickening of the feeds was not uniformly performed among the aerodigestive centers as a therapy method for the children with swallowing dysfunction with aspiration. Conclusion: In the survey, physicians mentioned about the importance of better guidelines for aspiration, the requirement of new diagnostic measures, the necessity of multicenter trials of sensitivity and specificity of current diagnostic tools, and developing a scoring system for reading the radiological studies for children with oropharyngeal aspiration.

Upper Endoscopy in Patients with Extra-Oesophageal Reflux Symptoms: A Multicentre Study

Background: There are no evidence-based recommendations for performing upper gastrointestinal endoscopy (UGIE) in patients with extra-oesophageal symptoms of gastro-oesophageal reflux disease (GORD). However, UGIEs are often performed in clinical practice in these patients. We aimed to assess the prevalence of gastro-oesophageal lesions in patients with atypical GORD symptoms. Methods: Patients complaining of at least one extra-oesophageal GORD symptom and undergoing UGIE in seven centres were prospectively enrolled. Clinically relevant lesions (Barrett’s oesophagus, erosive oesophagitis, gastric precancerous conditions, peptic ulcer, cancer, and H. pylori infection) were statistically compared between groups regarding GORD symptoms (atypical vs. both typical and atypical), type of atypical symptoms, age, and presence of hiatal hernia. Results: Two hundred eleven patients were enrolled (male/female: 74/137; mean age: 55.5 ± 14.7 years). Barrett’s oesophagus was detected in 4 (1.9%), erosive oesophagitis in 12 (5.7%), gastric precancerous conditions in 22 (10.4%), and H. pylori infection in 38 (18%) patients. Prevalence of clinically relevant lesions was lower in patients with only atypical GORD symptoms (28.6 vs. 42.5%; p = 0.046; χ² test), in patients ≤50 years (20 vs. 44.8%; p = 0.004; χ² test), and in those in ongoing proton pump inhibitor (PPI) therapy (21.1 vs. 40.2%; p = 0.01; χ² test). No clinically relevant lesions were detected in patients ≤50 years, without alarm symptoms, and receiving PPI therapy. Hiatal hernia was diagnosed in only 6 patients with cardiologic and in 41 patients with ear-nose-throat symptoms (11.3 vs. 35.1%; p = 0.03; χ² test). Conclusions: Clinically relevant lesions are uncommon among young (≤50 years) patients with extra-oesophageal GORD symptoms. Hiatal hernia is not more prevalent in patients with cardiologic symptoms and suspicion of GORD. The usefulness of UGIE in these patients is questionable.

Infantlarda ve Çocuklarda Gastroözefagial Reflü Hastalığının Gastoözefagial Reflü Sintigrafisi ile Değerlendirilmesi

AbstractAim: Our goal was to evaluate the gastric emptying time in either reflux positive and negative children; and also the first reflux time, the number of reflux episodes in scintigraphy, reflux index (RI), and gastric emptying half time for liquids in infants and in children who were referred to our department for gastroesophageal reflux scintigraphy (GERS) with suspicion of gastroesophageal reflux disease (GERD).Material and Methods: Dynamic GERS images were first evaluated visually and then regions of interests (ROI) were drawn on esophagus, stomach and background. Time-activity curves were generated and obtained values were statistically evaluated.Results: Among 208 patients 38.5 % of the patients were reflux positive (80/208). There was a positive correlation between degree of reflux and gastric emptying half‐time (p<0.001, r= 0.274) and there was a negative correlation between the degree of reflux and the gastric emptying percentages (p<0.001, r= -0.259). There were no significant differences between first reflux time and the reflux grades of patients and also there were no significant differences between RI and reflux grades of patients (p>0.05). Conclusion: Our results show, in all groups, patients with high number of reflux episodes have longer gastric emptying half‐time with lower gastric emptying percentages. However, between groups, no significant difference was found in terms of gastric emptying percentage or gastric emptying half‐time. Consequently, independently of age groups, quantitative analysis of GERS should include both the visual analysis of the reflux and also the quantification of gastric emptying half time, gastric emptying percentage which may contribute diagnosis.

The diagnostic value of GerdQ in subjects with atypical symptoms of gastro-esophageal reflux disease

Background: Symptoms are essential in the clinical diagnosis of gastro-esophageal reflux disease (GERD). Questionnaires such as GerdQ have been developed as diagnostic aids. GerdQ has been thoroughly validated in well-characterized GERD patients, but has not yet been fully evaluated in a population that includes subjects with atypical symptoms.Aim: To evaluate GerdQ in a population with typical and/or atypical symptoms of GERD, defined by 24-h pH monitoring. The secondary aim was to investigate the outcome of GerdQ depending on the response to proton pump inhibitor (PPI) treatment.Methods: The study included 646 subjects referred for 24-h pH monitoring due to a clinical suspicion of GERD. All subjects completed GerdQ before performing a 24-h pH monitoring.Results: In total, 377 (58%) subjects were diagnosed with GERD based on symptoms and 24-h pH monitoring (GERDpH). Of these, 46% had atypical main symptoms. Overall, GerdQ (at cut-off 8) predicted GERDpH with a sensitivity and specificity of 62% and 74%, respectively. A high specificity but poor sensitivity for diagnosis of GERDpH was found for atypical main symptoms such as cough, dysphagia and globus. GerdQ had a relatively high sensitivity and specificity in predicting PPI response and a PPV of 99% at cut-off 8.Conclusions: GerdQ has a diagnostic value in an unselected population presenting with typical and/or atypical symptoms of GERD, but a low sensitivity for diagnosis of GERDpH was found in subjects with predominant symptoms such as cough, dysphagia and globus.

PTU-143 Clinical Yield of Using Common Reflux-Symptom Correlation Methods: A Retrospective Study Comparing The Demeester Score, Symptom Index, and Symptoms Association Probability in Predicting Response to Antireflux Treatment in Patients with GORD

Introduction Oesophageal pH-impedance monitoring is the gold standard for the diagnosis of gastroesophageal reflux disease (GORD). The DeMeester score is a global measure of acid exposure calculated from reflux parameters. Symptom Index (SI) and the Symptoms Association Probability (SAP) scores correlate symptoms to episodes of gastroesophageal reflux (GOR). Currently, it is not clear which of these scoring methods best relate to the patient’s response to treatment. This study investigates the value of these 3 metrics in predicting the clinical outcome of treatment in GORD patients. Methods We retrospectively selected patients who had 24 hour pH-impedance monitoring on suspicion of GORD during December 2014 to October 2015. Abnormal DeMeester was defined as ≥14.72, +ve SI as ≥50%, and +ve SAP as ≥95%. The Reflux Disease Questionnaire (RDQ) was completed by each patient before investigation. After reflux monitoring, patients were followed up to calculate their post-treatment RDQ at least 2 months post treatment. Sensitivity, specificity, positive and negative likelihood ratios and predictive values were calculated. Results 42 patients (11 male; total mean age 51 [25–79]) were included. 25 (59.52%) of these patients were treated. Of these, 21 patients, had medical treatment and 6 had surgical treatment (2 had both). 10/25 (40%) had a reduced RDQ score post-treatment: 8/10 (80%) having medical treatment, 1/6 (23.33%) having surgical treatment. In patients without treatment, 7/17 (41.18%) had a reduced RDQ. The two-tailed p value between the treated and untreated group was not significant (p = 1.00). Considering individual metrics, abnormal DeMeester score showed highest specificity and SAP showed the highest sensitivity in predicting lowering RDQ score post-treatment. When combining different metrics, having all three parameters positive yielded the highest overall clinical value: sensitivity 60%, specificity 95%, positive likelihood ratio 12, positive predictive value 75%, negative predictive value 90% (table 1). Conclusion In patients diagnosed with GORD by pH-impedance monitoring, having all three parameters positive i.e. abnormal DeMeester score, SAP +ve and SI +ve had a high overall value in predicting the response to treatment. Nevertheless, reduction of RDQ was equally seen in untreated GORD group. A study on a larger number of patients might be required to further confirm the findings of this research Disclosure of Interest None Declared

PP‐8 ESOPHAGEAL HIGH RESOLUTION MANOMETRY IN NEUROLOGICALLLY IMPAIRED CHILDREN AND GASTRO‐OESOPHAGEAL REFLUX DISEASE

Objectives:Mechanism underlying the occurrence of Gastroesophageal reflux disease (GERD) in neurologically impaired children (NIC) is poorly understood. We sought to characterize, by Esophageal High Resolution Manometry (EHRM), alterations of esophageal motility associated with GERD in NIC and to compare with a group with a suspicion of GERD and normal psychomotor development (NDP).Methods:EHRM and multichannel intraluminal impedance/pH‐metry (MII/pH) were conducted in 7 NIC and 9 patients with suspicion of GERD and NPD. Esophagogastric junction relaxation (EGJr), the presence/pressure troughs of the oesophageal segments, the distal contractile integral adjusted for esophageal length (DCIa) and the pressurization frontal velocity (PFV) were analyzed by EHRM.Results:Three out of 7 NIC (42.8%) and 4 out of 9 patients with NPD (44.4%) resulted positive to MII/pH (p = 1). No statistical differences were observed for EGJr and PFV between NIC and NPD patients. DCIa was significantly lower in NIC subjects respect to NPD patients (p < 0.01). Comparing NIC with GERD and patients with GERD and NPD we found that third segment was absent in 2/3 (66,6 %) of NIC respect to NPD patients (p < 0.05) and that the third pressure trough was significantly lower in NIC respect to NPD patients (p < 0.05). There were no statistical differences with respect to the first and second pressure trough between NIC and NDP patients.Conclusions:NIC have esophageal motor dysfunction that can be detected by EHRM. Some esophageal manometric alterations could be predictive of GERD in NIC and could explain a different pathogenesis of GERD in NIC and in patients with NPD.

Frequency and risk factors of gastric and duodenal ulcers or erosions in children: a prospective 1-month European multicenter study

There are no solid figures of the frequency of ulcer disease during childhood in Europe. We assessed its frequency and analyzed known risk factors. Ulcers, erosions, indications, and risk factors were recorded in all children undergoing an upper gastrointestinal endoscopy in a prospective study carried out during 1-month simultaneously in 19 centers among 14 European countries. Ulcers and/or erosions were observed in 56 out of 694 children. Children with ulcers/erosions were significantly older than those without lesions (10.3+/-5.5 vs. 8.1+/-5.7 years, P=0.002). Helicobacter pylori infection was present in 15 of 56 children (27%) where NSAIDs were used in eight, steroids in five, immune-suppressive drugs in five, antibiotics in six, antacids in one, H2-blockers in six and proton pump inhibitors in eight children (more than one risk factor was detected in 32 of 56 children). No risk factors were observed in 24 of 56 children (43%). The main indications for endoscopy were epigastric or abdominal pain (24%) and suspicion of gastroesophageal reflux disease (15%). Similarly, epigastric tenderness, hematemesis, melena, and weight stagnation were significantly associated with ulcers/erosions, whereas sex, H. pylori infection, socioeconomic and lifestyle factors were equally distributed. Although limited by the short-time duration and the heterogeneity of the patients included throughout the 19 centers, our study shows a frequency of 8.1% of ulcers and/or erosions in children, occurring mainly in the second decade of life. H. pylori infection and gastrotoxic medications were less frequently implicated than expected.

Refractory gastrooesophageal reflux disease

The introduction of proton pump inhibitors (PPIs) has facilitated the treatment of gastrooesophageal reflux disease (GORD) enormously; however, treatment of GORD still fails in a small proportion of patients. This small proportion of therapy-resistant patients encompasses a substantial part of the working load of physicians and has become a common clinical problem. A strong variability in acid-suppressive effect of PPI treatment exists depending on compliance, Helicobacter pylori status and genotype. Nocturnal acid breakthrough does not seem to be a major determinant of refractory GORD. Recent data, however, show that PPI-refractory GORD can result from nonacid reflux episodes. It is wise to reconsider the diagnosis of GORD in patients who are PPI-refractory. Most patients in whom a PPI is not effective do not have GORD, instead they suffer from other disorders such as functional dyspepsia. If after a thorough history is taken the suspicion of GORD is still high, the next step would be to perform upper endoscopy and reflux monitoring. In case patients truly have PPI-refractory GORD, therapy can be aimed at oesophageal hypersensitivity or a surgical solution can be sought.

Extraoesophageal symptoms and signs of gastroesophageal reflux disease

Background Gastroesophageal reflux disease (GERD) is very common in developed world, with the prevalence of disease is between 6 and 20%. Pathologic reflux can provoke not only typical symptoms (heartburn and regurgitation) but also atypical symptoms and diseases of extraoesophageal organs (pulmonary, ENT, mouth). High prevalence of GERD in patients with unexplained chest pain, asthma, chronic cough, chronic laryngitis, hoarsness and dental erosions is not a proof of causality. GERD can cause these diseases with reflux of acid and pepsin into pharynx, larynx, lungs and mouth (reflux theory) or through vasovagal mechanisms (reflex theory). Conclusions Good therapeutic success with medical or operative treatment in early methodologically not well conducted studies has not been completely proven in double-blind placebo controlled studies. GERD is an ethyological reason for these extraoesophageal symptoms and diseases in an approximately one third of patients. With diagnostic modalities that we have now, we cannot clearly define in which patient is GERD is an ethyologic factor or a contributer, before we start the treatment. In patients suspected of having GERD, there is therapeutic option of a trial with high dose of proton pump inhibitor for 3 to 6 months. In other patients with low clinical suspicion of GERD, 24-hour pH testing should be done first.

Intra-esophageal ph Probe Movement During Eating and Talking. A videoradiographic study

To registrate the oscillations of the pH probe in the esophagus during phonation and swallowing in the erect and supine positions. Sixty-seven patients with suspicion of gastroesophageal reflux disease underwent manometry, 24-h pH monitoring, and videoradiography. In 43 patients the effect of dry, wet, and solid swallows in the erect and supine positions was determined, making a total of 258 swallows. In another 24 patients the effect of pH probe movement during phonation was studied. During every swallow the probe moved in the proximal direction from 0.5 to 2.0 cm, returned to baseline, and in 48 swallows an additional descendent movement of up to 2.0 cm was seen, the last mentioned more pronounced during solid swallows. In the erect position, no significant difference was observed for the different swallowing types, whereas in the supine position, movements were significantly more pronounced during solid food swallows. During phonation the pH probe only ascended and returned to the baseline, with no descending part. The pH probe movements are dependent on body position, bolus size, bolus composition, and talking. The ascending movements can only partially compensate for the esophageal shortening during swallow because of the time difference, and could perhaps explain the variation in results and reproducibility of 24-h pH monitoring.

Intra-esophageal pH probe movement during eating and talking. A videoradiographic study.

To registrate the oscillations of the pH probe in the esophagus during phonation and swallowing in the erect and supine positions. Sixty-seven patients with suspicion of gastroesophageal reflux disease underwent manometry, 24-h pH monitoring, and videoradiography. In 43 patients the effect of dry, wet, and solid swallows in the erect and supine positions was determined, making a total of 258 swallows. In another 24 patients the effect of pH probe movement during phonation was studied. During every swallow the probe moved in the proximal direction from 0.5 to 2.0 cm, returned to baseline, and in 48 swallows an additional descendent movement of up to 2.0 cm was seen, the last mentioned more pronounced during solid swallows. In the erect position, no significant difference was observed for the different swallowing types, whereas in the supine position, movements were significantly more pronounced during solid food swallows. During phonation the pH probe only ascended and returned to the baseline, with no descending part. The pH probe movements are dependent on body position, bolus size, bolus composition, and talking. The ascending movements can only partially compensate for the esophageal shortening during swallow because of the time difference, and could perhaps explain the variation in results and reproducibility of 24-h pH monitoring.

Gastro-oesophageal reflux demonstrated by radiography. A supplement to 24-h pH monitoring.

Gastro-oesophageal reflux (GOR) is demonstrated by radiography as a supplement to 24-h pH monitoring. Forty-two patients (mean age 44 years) with suspicion of GOR disease were assessed according to a standard questionnaire. GOR was investigated by 24-h pH-monitoring and by radiography. Oesophageal emptying and the presence of rings or strictures were registered as well. Mucosal biopsies, classified as normal, light oesophagitis, severe oesophagitis, or Barrett's oesophagus, were correlated to age, gender, symptomatology, pH monitoring, and oesophageal emptying. GOR and morphological changes demonstrated by radiography were correlated to pH monitoring and mucosa biopsies. Based on pH monitoring, patients with severe oesophagitis and Barrett's oesophagus had a significantly higher acid exposure compared to patients with normal mucosa and light oesophagitis, with no difference concerning age, gender, and symptoms. Severe oesophagitis, including Barrett's oesophagus, was found only in patients with a positive test for radiologic GOR. Eleven patients had rings or strictures independent of oesophageal mucosal changes. GOR demonstrated by radiography identified patients where complications could be expected, which was not possible by pH monitoring alone.

Gastro-oesophageal reflux demonstrated by radiography. . A supplement to 24-h pH monitoring

Gastro-oesophageal reflux (GOR) is demonstrated by radiography as a supplement to 24-h pH monitoring. Forty-two patients (mean age 44 years) with suspicion of GOR disease were assessed according to a standard questionnaire. GOR was investigated by 24-h pH-monitoring and by radiography. Oesophageal emptying and the presence of rings or strictures were registered as well. Mucosal biopsies, classified as normal, light oesophagitis, severe oesophagitis, or Barrett's oesophagus, were correlated to age, gender, symptomatology, pH monitoring, and oesophageal emptying. GOR and morphological changes demonstrated by radiography were correlated to pH monitoring and mucosa biopsies. Based on pH monitoring, patients with severe oesophagitis and Barrett's oesophagus had a significantly higher acid exposure compared to patients with normal mucosa and light oesophagitis, with no difference concerning age, gender, and symptoms. Severe oesophagitis, including Barrett's oesophagus, was found only in patients with a positive test for radiologic GOR. Eleven patients had rings or strictures independent of oesophageal mucosal changes. GOR demonstrated by radiography identified patients where complications could be expected, which was not possible by pH monitoring alone.

Clinical presentation as a guide to the identification of GERD in children

Objective: to determine if there is a correlation between common otolaryngologic symptoms and presence of gastroesophageal reflux disease (GERD) in children. Methods: charts of 295 children presenting with suspicion of GERD were reviewed for presenting symptoms including: (1) airway symptoms: stertor, stridor, frequent cough, recurrent croup, wheezing, nasal congestion, obstructive apnea, blue spells, hoarseness, throat clearing; (2) feeding symptoms: wet burps, globus sensation, frequent emesis, dysphagia, choking/gagging, sore throat, halitosis, food refusal, stomach aches, arching, drooling, chest pain, irritability, and failure to thrive. At least one positive test of barium esophagram, gastric scintiscan, pH probe or esophageal biopsy resulted in inclusion in the GERD positive group. Results: 214 children had GERD diagnosed while 81 had no positive tests for GERD. Between the GERD positive and GERD negative groups, the significantly different symptoms were stertor ( P=0.040), cyanotic spells ( P=0.043), frequent emesis ( P=0.007), failure to thrive ( P=0.006), and choking/gagging ( P=0.044). Three pooled variables were created: airway flow (stertor, stridor, cyanotic spells), airway irritation (frequent cough, recurrent croup, throat clearing), and feeding (dysphagia, failure to thrive, frequent emesis). GERD patients who were 2 years or less were compared to those older than 2 years and all three of these pooled variables were significantly different between these groups ( P<0.001). Conclusion: children who present with a certain constellation of airway or feeding symptoms are more likely to have a positive GERD test. Children 2 years old or less are more likely to present with airway symptoms or feeding difficulties while children older than 2 years are more likely to present with airway irritation.

Radiographic pulmonary changes of gastro-oesophageal reflux disease in elderly patients.

The aim of this study was to investigate the association of gastro-oesophageal reflux disease (GORD) with radiographic pulmonary changes. One hundred and thirty-seven patients aged over 60 years referred for endoscopy for abdominal symptoms were included in the study. In patients with any suspicion of GORD (n = 95), 24-hour oesophageal pH monitoring was carried out. All the patients were interviewed before the examinations. Chest radiography was performed in all patients. Odds ratio of respiratory symptoms was 8.7 (95% confidence interval 3.4-22.4) in patients with total reflux time of more than 10% compared with those who had total reflux time of less than 10%. In chest radiography, bilateral pleural adhesions and thickenings and bilateral parenchymal scars were significantly more common in patients with, than in those without, regurgitation or large hiatal openings. The occurrence of bilateral scars and pleural thickenings increased with the extent of gastro-oesophageal reflux in pH monitoring. Odds ratios of bilateral pleural thickening and pulmonary scars were 3.1 (95% confidence interval 0.8-11.5) and 5.8 (1.1-29.6) in patients with total reflux time over 10%, compared with patients who had normal total reflux time. The findings indicate that respiratory involvement is a characteristic feature of GORD in elderly patients.