title: Duodenogastro-esophageal reflux in children with refractory gastro-esophageal reflux disease.
abstract: 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.
authors.affiliation: Division of Pediatrics, University Hospitals Leuven, Belgium. ilse.hoffman@uz.kuleuven.ac.be
authors.forename: Ilse
authors.initials: I
authors.lastname: Hoffman
authors.forename: Alexander
authors.initials: A
authors.lastname: Tertychnyy
authors.forename: Nadine
authors.initials: N
authors.lastname: Ectors
authors.forename: Toon
authors.initials: T
authors.lastname: De Greef
authors.forename: Nancy
authors.initials: N
authors.lastname: Haesendonck
authors.forename: Jan
authors.initials: J
authors.lastname: Tack
mesh_terms: 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
chemical_list: D000897:Anti-Ulcer Agents; D009853:Omeprazole