title: Patterns of reflux in gastroesophageal reflux disease in pediatric population of New South Wales.
abstract: This study is to determine the association of ambulatory pH monitoring (24hr pH) with symptoms of gastroesophageal reflux and its other investigations. The clinical and epidemiological profiles of subjects referred for reflux disorders are also studied. Symptoms or group of symptoms, profiles and prior investigations of 1259 consecutive pediatric subjects (with 1332 24hr pH studies performed) referred for evaluation of reflux disorders between 1988 and 2012 were retrospectively studied. Chi-square or fisher exact test was used for hypothesis testing, student t-test for the comparison of means and the Wilcoxon rank-sum test for comparing medians of continuous variables. Gastroesophageal reflux disease (GERD), defined as reflux causing major symptoms and complications, was diagnosed in 57.5% subjects of the total sample. Forty-three percent were girls and 56.7% were boys. The most common age group was between 4 months and 2 years (51.2%). Vomiting (64.4%) and irritability (74%) were the most common symptoms with the neurological conditions (23.2%) being the most frequent underlying condition. The parameters used in 24hr pH were significantly higher in those diagnosed with GERD (P < 0.0001). The prevalence of GERD was found to be significantly higher when both gastrointestinal and respiratory symptoms were present (P = 0.008) at 66.4% than when compared with gastrointestinal (56.5%) and respiratory (52.2%) symptoms in isolation. Symptoms alone were not reliable in diagnosing GERD. Only 57.5% had GERD among patients referred for reflux disorders. 24hr pH is reliable and should be considered routine in reflux disorders, as it identifies patients with pathologic reflux and avoids a needless surgery.
authors.affiliation: Department of Pediatric Surgery, Institute of Maternal and Child Health, Government Medical College, Kozhikode, Kerala, India.
authors.forename: Sarath Kumar
authors.initials: SK
authors.lastname: Narayanan
authors.affiliation: Department of Chemistry, University of California, Berkeley, 419 Latimer Hall, Berkeley, CA, United States.
authors.forename: Ralph Clinton
authors.initials: RC
authors.lastname: Cohen
authors.affiliation: Discipline of Pediatrics and Child Health, University of Sydney, Sydney, NSW, Australia.|Department of Surgery, The Children's Hospital at Westmead, Sydney, NSW, Australia.
authors.forename: Jonathan Saul
authors.initials: JS
authors.lastname: Karpelowsky
mesh_terms: D016009:Chi-Square Distribution; D002675:Child, Preschool; D050782:Esophageal pH Monitoring / Q000379:methods*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D063189:Symptom Assessment / Q000379:methods*
keywords: fundoplication; gastroesophageal reflux; impedance study; pH monitoring