Diagnostic modalities for gastroesophageal reflux.
OBJECTIVE
To evaluate commonly utilized diagnostic modalities to detecting Gastroesophageal Reflux (GER).


METHODS
Sixty children aged 1-72 months (mean age 14.7 months) with symptoms suggestive of Gastroesosphageal Reflux (GER) were investigated and subjected to upper gastrointestinal endoscopy and esophageal biopsy (EB), gastroesophageal scintiscanning (GS) and 24 hour ambulatory pH monitoring.


RESULTS
GER was detected in 28 (46.7%) cases by one or more diagnostic modalities. Ambulatory 24 hour pH monitoring was positive in higher proportion (43.3%) of cases in comparison to other modalities, followed by EB (38.3%) and GS (30%). Considering 24 hour pH monitoring as the gold standard, esophageal biopsy was positive in 22/26 cases (84.6%) detected by 24 hour pH monitoring with a specificity of 97.1% as compared to 17/26 cases (65.4%) by gastroesophageal scintiscanning with a specificity of 97.1%. When compared with EB results, amongst various parameters measured during 24 hour pH monitoring, Reflux index (RI) ranked highest (sensitivity 95.6 % and specificity 89.2 %) followed by duration of longest episode > 20 minutes and Euler Byrne score. Oscillatory index, calculated from tracings of pH monitoring, even though ranked lower because of its low sensitivity helped to pick up 2 cases missed by EB and RI.


CONCLUSIONS
Our results suggest that a combination of diagnostic modalities may be required to diagnose GER in young children. Ambulatory 24 hour pH monitoring appears to be the single best investigation and combining it with EB and/or GS can help to detect maximum number of cases.
Patwari
A K
AK
Department of Pediatrics LHMC and Associated Kalawati Saran Children's Hospital, New Delhi, India. akpatwari@hotmail.com
Bajaj
Pramila
P
Kashyp
Ravi
R
Anand
V K
VK
Gangil
Ashutosh
A
Jain
Amit
A
Kapoor
Gaurav
G
D001707:Biopsy, Needle; D002648:Child; D002675:Child, Preschool; D003938:Diagnostic Techniques, Digestive System; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011877:Radionuclide Imaging / Q000379:methods; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index