title: Gastroesophageal Reflux Burden, Even in Children That Aspirate, Does Not Increase Pediatric Hospitalization.
abstract: Gastroesophageal reflux is common but remains a controversial disease to diagnose and treat and little is known about the role of reflux testing in predicting clinical outcomes, particularly in children at risk for extraesophageal reflux complications. The aim of this study was to determine if rates of hospitalization were affected by reflux burden even after adjusting for aspiration risk.
  
  
  
  We prospectively recruited, between 2009 and 2014, a cohort of pediatric patients with suspected extraesophageal reflux disease who were referred for reflux testing and underwent both multichannel intraluminal impedance with pH (pH-MII) and modified barium swallow studies. A subset of patients also underwent bronchoalveolar lavage with pepsin analysis. We determined their rates of hospitalization for a minimum of 1 year following pH-MII testing.
  
  
  
  We prospectively enrolled 116 pediatric patients who presented for care at Boston Children's Hospital and underwent both pH-MII and modified barium swallow studies. There was no statistically significant relationship between reflux burden measured by pH-MII or bronchoalveolar pepsin and total number of admissions or number of admission nights even after adjusting for aspiration status (P > 0.2). There were no statistically significant relationships between reflux burden by any method and the number or nights of urgent pulmonary admissions before or after adjusting for aspiration risk (P > 0.08).
  
  
  
  Even in aspirating children, reflux burden did not increase the risk of hospitalization. Based on these results, routine reflux testing cannot be recommended even in aspirating children, because the results do not impact clinically significant outcomes.
authors.affiliation: *Aerodigestive Center, Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, MA †Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee ‡Clinical Research Program, Boston Children's Hospital, MA §Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, MA.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Duncan
authors.forename: Janine
authors.initials: J
authors.lastname: Amirault
authors.forename: Nikki
authors.initials: N
authors.lastname: Johnston
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
authors.forename: Kara
authors.initials: K
authors.lastname: Larson
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Rosen
mesh_terms: D000293:Adolescent; D001900:Boston; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D053120:Respiratory Aspiration / Q000209:etiology* / Q000628:therapy; D018570:Risk Assessment