Duodenogastro-esophageal reflux in children with refractory gastro-esophageal reflux disease.
OBJECTIVE
To determine the role of duodenogastro-esophageal reflux (DGER) in the pathogenesis of refractory gastro-esophageal reflux disease (GERD) in children.


METHODS
Twenty-two patients (12 boys, mean age, 13.2 years) with GERD symptoms that persisted on omeprazole (1 mg/kg) underwent upper gastrointestinal endoscopy and barium x-ray, 24-hour pH and DGER (Bilitec) monitoring, and a 13C octanoic acid gastric emptying breath test.


RESULTS
Patients presented mainly with epigastric pain, regurgitation, and nausea. Endoscopy revealed persistent esophagitis in 15 patients (68%). Pathologic acid and DGER exposure were present in 12 (55%) and 15 (68%) children, respectively, with combined pathologic reflux in 10 (45%). Acid exposure did not differ according to the presence of esophagitis, but patients with grade II esophagitis had significantly higher DGER exposure than those without esophagitis (9.1 +/- 5.3% vs 26.7 +/- 10.9% of the time, P < .05). Gastric emptying rate was not associated to acid or DGER exposure or persisting esophagitis. Symptoms improved after adding a prokinetic drug to the proton pump inhibitor therapy or referral for surgery (n = 5).


CONCLUSIONS
DGER may play a role in the pathophysiology of proton pump inhibitor-refractory GERD and esophagitis in children.
Hoffman
Ilse
I
Division of Pediatrics, University Hospitals Leuven, Belgium. ilse.hoffman@uz.kuleuven.ac.be
Tertychnyy
Alexander
A
Ectors
Nadine
N
De Greef
Toon
T
Haesendonck
Nancy
N
Tack
Jan
J
D000293:Adolescent; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001944:Breath Tests; D002648:Child; D004386:Duodenum / Q000503:physiopathology*; D016145:Endoscopy, Digestive System; D016099:Endoscopy, Gastrointestinal; D004941:Esophagitis / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005746:Gastric Emptying; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D009853:Omeprazole / Q000627:therapeutic use
D000897:Anti-Ulcer Agents; D009853:Omeprazole