title: Sonographic measurement of the abdominal esophagus length in infancy: a diagnostic tool for gastroesophageal reflux.
abstract: OBJECTIVE
  Our aim was to provide exact sonographic measurements of the abdominal esophagus length in neonates and infants with and without gastroesophageal reflux (GER) and to investigate its diagnostic value. GER severity and hiatal hernia presence were also evaluated and correlated with esophageal length.
  
  
  METHODS
  This retrospective case-control study comprised 258 neonates and infants (150 without reflux and 108 with reflux). There were 50 children without reflux in each of three age categories: less than 1 month, 1-6 months, and 6-12 months. Of the children with reflux, 42 were less than 1 month old; 34, 1-6 months; and 32, 6-12 months. The abdominal esophagus was measured from its entrance into the diaphragm to the base of gastric folds in fed infants. The number of refluxes during a 10-min period were recorded; GER was categorized as mild, one to three refluxes; moderate, three to six refluxes; and severe, more than six refluxes. Presence of hiatal hernia was recorded.
  
  
  RESULTS
  Neonates and infants with reflux had a significantly shorter abdominal esophagus than subjects without reflux: the mean difference in neonates, 4.8 mm; 1-6 months, 4.5 mm; 6-12 months, 3.4 mm. Children with severe reflux had a shorter esophagus compared with those with mild and moderate reflux only in the neonate group. In contrast, children with reflux associated with hiatal hernia had a significantly shorter esophagus compared with children with mild reflux in all three age groups. Sonographic sensitivity was 94%.
  
  
  CONCLUSIONS
  Sonographic measurement of the abdominal esophagus length is highly diagnostic for GER in neonates and infants. In neonates, it can also indicate GER severity. Hiatal hernia is associated with a significantly shorter abdominal esophagus.
authors.affiliation: Department of Radiology, Agia Sofia Children's Hospital, Thivon and Mikras Asias Sts., Goudi, Athens 11527, Greece.
authors.forename: C
authors.initials: C
authors.lastname: Koumanidou
authors.forename: M
authors.initials: M
authors.lastname: Vakaki
authors.forename: G
authors.initials: G
authors.lastname: Pitsoulakis
authors.forename: A
authors.initials: A
authors.lastname: Anagnostara
authors.forename: P
authors.initials: P
authors.lastname: Mirilas
mesh_terms: D016022:Case-Control Studies; D004947:Esophagus / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000000981:diagnostic imaging*; D006551:Hernia, Hiatal / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014463:Ultrasonography