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US in the diagnosis of gastroesophageal reflux in children

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Abstract

Several techniques have been used to diagnose gastroesophageal reflux (GER) in children, but no single test is sufficiently accurate to completely investigate the problem. Gastroesophageal US has been described as a widely available, noninvasive and sensitive method. It provides morphological and functional information, but its role in the diagnosis of GER in children is still debated. In this paper we review diagnostic approaches to GER in children. We focus on current use of US in the management of children with suspected GER. Reports suggest that US allows exclusion of several non-GER causes of symptoms and that it provides morphological and functional data with high sensitivity and positive predictive value for the diagnosis of GER. Sonographic assessment of findings such as abdominal esophageal length, esophageal diameter, esophageal wall thickness and gastroesophageal angle provide important diagnostic indicators of reflux and related to the degree of GER. There is a need for standardization of the procedure and for defining diagnostic criteria.

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References

  1. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) (2009) J Pediatr Gastroenterol Nutr 49:498-547

  2. Koumanidou C, Vakaki M, Pitsoulakis G et al (2004) Sonographic measurement of the abdominal esophagus length in infancy: a diagnostic tool for gastroesophageal reflux. AJR 183:801–807

    PubMed  CAS  Google Scholar 

  3. Gomes H, Lallemand A, Lallemand P (1993) Ultrasound of the gastroesophageal junction. Pediatr Radiol 23:94–99

    Article  PubMed  CAS  Google Scholar 

  4. Gomes H, Menanteau B (1991) Gastroesophageal reflux: comparative study between sonography and pH monitoring. Pediatr Radiol 21:168–174

    Article  PubMed  CAS  Google Scholar 

  5. Jang HS, Lee JS, Lim GY et al (2001) Correlation of Color Doppler sonographic findings with pH measurements in gastroesophageal reflux in children. J Clin Ultrasound 29:212–217

    Article  PubMed  CAS  Google Scholar 

  6. Vandenplas Y, Goyvaerts H, Helven R et al (1991) Gastroesophageal reflux, as measured by 24-hour pH monitoring, in 509 healthy infants screened for risk of sudden infant death syndrome. Pediatrics 88:834–840

    PubMed  CAS  Google Scholar 

  7. Herbst JJ (1981) Gastroesophageal reflux. J Pediatr 98:859–870

    Article  PubMed  CAS  Google Scholar 

  8. Working Group of the European Society of Pediatric Gastroenterology and Nutrition (1992) A standardized protocol for the methodology of esophageal pH monitoring and interpretation of the data for the diagnosis of gastroesophageal reflux. J Pediatr Gastroenterol Nutr 14:467–471

    Article  Google Scholar 

  9. Salvatore S, Hauser B, Vandemaele K et al (2005) Gastroesophageal reflux disease in infants: how much is predictable with questionnaires, pH-metry, endoscopy and histology? J Pediatr Gastroenterol Nutr 40:210–215

    Article  PubMed  Google Scholar 

  10. Esposito F, Lombardi R, Grasso AC et al (2001) Transabdominal sonography of the normal gastroesophageal junction in children. J Clin Ultrasound 29:326–331

    Article  PubMed  CAS  Google Scholar 

  11. Westra SJ, Wolf BH, Staalman CR (1990) Ultrasound diagnosis of gastroesophageal reflux and hiatal hernia in infants and young children. J Clin Ultrasound 18:477–485

    Article  PubMed  CAS  Google Scholar 

  12. Wenzl TG, Schenke S, Peschgens T et al (2001) Association of apnea and nonacid gastroesophageal reflux in infants: investigations with the intraluminal impedance technique. Pediatr Pulmonol 31:144–149

    Article  PubMed  CAS  Google Scholar 

  13. Zentilin P, Dulbecco P, Savarino E et al (2004) Combined multichannel intraluminal impedance and pH-metry: a novel technique to improve detection of gastro-oesophageal reflux literature review. Dig Liver Dis 36:565–569

    Article  PubMed  CAS  Google Scholar 

  14. Castell DO, Vela M (2001) Combined multichannel intraluminal impedance and pH-metry: an evolving technique to measure type and proximal extent of gastroesophageal reflux. Am J Med 111(S8A):157S–159S

    Article  PubMed  Google Scholar 

  15. Van Wijk MP, Benninga MA, Omari TI (2008) Role of the multichannel intraluminal impedance technique in infants and children. J Pediatr Gastroenterol Nutr 48:2–12

    Google Scholar 

  16. López-Alonso M, Moya MJ, Cabo JA et al (2006) Twenty-four-hour esophageal impedance-pH monitoring in healthy preterm neonates: rate and characteristics of acid, weakly acidic, and weakly alkaline gastroesophageal reflux. Pediatrics 118:299–308

    Article  Google Scholar 

  17. Taghavi SA, Ghasedi M, Saberi-Firoozi M et al (2005) Symptom association probability and symptom sensitivity index: preferable but still suboptimal predictors of response to high dose omeprazole. Gut 54:1067–1071

    Article  PubMed  CAS  Google Scholar 

  18. Caletti GC, Ferrari A, Mattioli S et al (1994) Endoscopy versus endoscopic ultrasonography in staging reflux esophagitis. Endoscopy 26:794–797

    Article  PubMed  CAS  Google Scholar 

  19. Vandenplas Y, Sacre-Smits L (1987) Continuous 24-hour esophageal pH monitoring in 285 asymptomatic infants 0–15months old. J Pediatr Gastroenterol Nutr 6:220–224

    Article  PubMed  CAS  Google Scholar 

  20. Vandenplas Y, Salvatore S, Devreker T et al (2007) Gastro-oesophageal reflux disease: oesophageal impedance versus pH monitoring. Acta Paediatr 96:956–962

    Article  PubMed  Google Scholar 

  21. Peter CS, Sprodowski N, Ahlborn V et al (2004) Inter- and intraobserver agreement for gastroesophageal reflux detection in infants using multiple intraluminal impedance. Biol Neonate 85:11–14

    Article  PubMed  Google Scholar 

  22. Sherman PM, Hassall E, Fagundes-Neto U et al (2009) A global, evidence-based consensus on the definition of gastroesophageal reflux disease in the pediatric population. Am J Gastroenterol 104:1278–1295

    Article  PubMed  Google Scholar 

  23. Kawahara H, Dent J, Davidson G (1997) Mechanisms responsible for gastroesophageal reflux in children. Gastroenterology 113:399–408

    Article  PubMed  CAS  Google Scholar 

  24. Di Lorenzo C, Piepsz A, Ham H et al (1987) Gastric emptying with gastro-oesophageal reflux. Arch Dis Child 62:449–453

    Article  PubMed  Google Scholar 

  25. Ravelli AM, Panarotto MB, Verdoni L et al (2006) Pulmonary aspiration shown by scintigraphy in gastroesophageal reflux-related respiratory disease. Chest 130:1520–1526

    Article  PubMed  Google Scholar 

  26. Fiorentino E, Barbiera F, Cabibi D et al (2007) Barium study associated with water siphon test in gastroesophageal reflux disease and its complications. Radiol Med 112:777–786

    Article  PubMed  CAS  Google Scholar 

  27. Aksglaede K, Pedersen JB, Lange A et al (2003) Gastro-esophageal reflux demonstrated by radiography in infants less than 1year of age. Comparison with pH monitoring. Acta Radiol 44:136–138

    Article  PubMed  CAS  Google Scholar 

  28. Fallahi G, Saneian H, Mahdizadeh M et al (2007) Children, gastroesophageal reflux and ultrasound. Acta Med Iran 45:355–360

    Google Scholar 

  29. Maheshwari P, Abograra A, Shamam O (2009) Sonographic evaluation of gastrointestinal obstruction in infants: a pictorial essay. J Pediatr Surg 44:2037–2042

    Article  PubMed  Google Scholar 

  30. Chavhan GB, Masrani S, Thakkar H et al (2004) Sonography in the diagnosis of pediatric gastrointestinal obstruction. J Clin Ultrasound 32:190–199

    Article  PubMed  Google Scholar 

  31. Milocco C, Salvatore CM, Torre G et al (1997) Sonography versus continuous 24 hours oesophageal pH-monitoring in the diagnosis of infant gastroesophageal reflux. Pediatr Med Chir 19:245–246

    PubMed  CAS  Google Scholar 

  32. Matrunola M, Grandin A, Mazza ML et al (2003) Role of radiography and ultrasonography in the diagnosis of the pediatric gastro-esophageal reflux disease. Eur Rev Med Pharmacol Sci 7:147–149

    PubMed  CAS  Google Scholar 

  33. Le Dosseur P, Moutounet L, Eurin D et al (1994) Ultrasonography of the esophagus in children. Ann Radiol 37:494–499

    PubMed  Google Scholar 

  34. Farina R, Pennisi F, La Rosa M et al (2008) Contrast-enhanced colour-Doppler sonography versus pH-metry in the diagnosis of gastro-oesophageal reflux in children. Radiol Med 113:591–598

    Article  PubMed  CAS  Google Scholar 

  35. Hirsch W, Kedar R, Preiss U (1996) Color Doppler in the diagnosis of the gastroesophageal reflux in children: comparison with pH measurements and B-mode ultrasound. Pediatr Radiol 26:232

    Article  PubMed  CAS  Google Scholar 

  36. Di Mario M, Bergami G, Fariello G et al (1995) Diagnosis of gastroesophageal reflux in childhood. Comparison of ultrasonography and barium swallow. Radiol Med 89:76–81

    PubMed  Google Scholar 

  37. Westra SJ, Derkx HH, Taminiau JA (1994) Symptomatic gastroesophageal reflux: diagnosis with ultrasound. J Pediatr Gastroenterol Nutr 19:58–64

    Article  PubMed  CAS  Google Scholar 

  38. Tani G, Sciutti R, Teglia F et al (1993) Diagnosis of gastro-esophageal reflux in children. Ultrasonography versus pH monitoring. Radiol Med 86:626–629

    PubMed  CAS  Google Scholar 

  39. Riccabona M, Maurer U, Lackner H et al (1992) The role of sonography in the evaluation of gastro-oesophageal reflux-correlation to pH-metry. Eur J Pediatr 151:655–657

    Article  PubMed  CAS  Google Scholar 

  40. Lazzari R, Collina A, Pession A et al (1991) The diagnosis of gastroesophageal reflux in childhood: a comparison between echography and pH measurement. Pediatr Med Chir 13:617–619

    PubMed  CAS  Google Scholar 

  41. Ponticelli A, Guarino N, Bergami GL et al (1997) E’utile l’ecografia esofagea nello screening del RGE in età pediatrica? Riv Ital Pediatr 23:1036–1039

    Google Scholar 

  42. Halkiewicz F, Kasner J, Karczewska K et al (2000) Ultrasound picture of gastroesophageal junction in children with reflux disease. Med Sci Monit 6:96–99

    PubMed  CAS  Google Scholar 

  43. Hashemi H, Mehdizadeh M, Shakiba M (2009) Diagnostic efficacy of distal esophagus ultrasonography in diagnosis of gastroesophageal reflux disease in children. Res J Biol Sci 4:71–76

    Google Scholar 

  44. Dehdashti H, Dehdashtian M, Rahim F et al (2011) Sonographic measurement of abdominal esophageal length as a diagnostic tool in gastroesophageal reflux disease in infants. Saudi J Gastroenterol 17:53–57

    Article  PubMed  Google Scholar 

  45. De Meester TR, Wernly JA, Bryant GH (1979) Clinical and in vitro analysis of determinants of gastroesophageal competence. A study of the principles of antireflux surgery. Am J Surg 137:39–43

    Article  Google Scholar 

  46. Karabulut B, Bostanci I, Kacar M et al (2010) Transcutaneous cervical and transabdominal ultrasonography as a diagnostic tool in gastroesophageal reflux in childhood. ORL 72:300–304

    PubMed  Google Scholar 

  47. Lucio-Villegas M, Arguelles MF, Coronel RC et al (1993) Diagnosis of gastroesophageal reflux: ultrasonographic method. An Esp Pediatr 39:431–434

    Google Scholar 

  48. Hirsch W, Preiss U, Kedar R (1997) Color coded Doppler ultrasound in diagnosis of gastroesophageal reflux. Klin Paediatr 209:6–10

    Article  CAS  Google Scholar 

  49. Yamada M, Kobayashi I, Kawamura N et al (1998) Color Doppler ultrasonography for evaluation of gastroesophageal reflux in a sick child. Acta Paediatr 87:229–230

    Article  PubMed  CAS  Google Scholar 

  50. Swischuk LE, Fawcett HD, Hayden CK Jr et al (1988) Gastroesophageal reflux: how much imaging is required? Radiographics 8:1137–1145

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, University of Chieti, Via dei Vestini 5, 66013, Chieti, Italy

    Alessandra Savino, Cristina Cecamore, Maria Ferrina Matronola, Alberto Verrotti, Angelika Mohn, Francesco Chiarelli & Piernicola Pelliccia

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  1. Alessandra Savino
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  2. Cristina Cecamore
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  3. Maria Ferrina Matronola
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  4. Alberto Verrotti
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Correspondence to Alessandra Savino.

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Savino, A., Cecamore, C., Matronola, M.F. et al. US in the diagnosis of gastroesophageal reflux in children. Pediatr Radiol 42, 515–524 (2012). https://doi.org/10.1007/s00247-012-2344-z

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  • DOI: https://doi.org/10.1007/s00247-012-2344-z

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