Paediatric gastro-oesophageal reflux: prognostic indicators from pH monitoring.
The original diagnostic 24 hour pH monitoring data in 57 children with gastro-oesophageal reflux (GOR) were retrospectively reviewed after a minimum of one year follow up. The tracings of children who responded to medical treatment were compared with those who failed to respond and required a fundoplication. Children with GOR secondary to oesophageal atresia/tracheo-oesophageal fistula and neurological conditions (n = 12) were analysed separately from those with primary GOR (n = 45). Children with primary GOR requiring a fundoplication (n = 9) had increased daytime reflux. The percentage time pH < 4 was the best discriminator (21% v 7%) with a threshold of 18% giving a 92% specificity and a 70% sensitivity. For children with secondary GOR the percentage time pH < 4 at night was significantly higher (29% v 3.7%) in those requiring a fundoplication (n = 5). A threshold of 18% gave an 80% specificity and an 86% sensitivity. These results show that both daytime and night time pH monitoring data can be of prognostic value in different subgroups of children with GOR. A percentage time pH < 4 of greater than 18% was a useful threshold to apply when evaluating the pH monitoring data.
Varty
K
K
Department of Paediatric Surgery, Queens Medical Centre, Nottingham.
Evans
D
D
Kapila
L
L
D002675:Child, Preschool; D002940:Circadian Rhythm / Q000502:physiology; D004947:Esophagus / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D005748:Gastric Fundus / Q000601:surgery; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000378:metabolism* / Q000628:therapy; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D008297:Male; D008991:Monitoring, Physiologic; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity