Title: Ultrasound evaluation of gastroesophageal junction in children with bronchial asthma and gastroesophageal reflux - correlations with clinical symptoms and pH monitoring
- Jarosław Kwiecień, Franciszek Halkiewicz, Edyta Machura
- Contemporary Pediatrics, Gastroenterology, Hepatology and Child Feeding
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- gastroesophageal reflux, asthma, ultrasound, pH-metry
Introduction: Ultrasound evaluation is often used in diagnosing gastroesophageal reflux (GER) in children. However, papers correlating various ultrasonographic pictures with pH monitoring are lacking.
Aim: The aim of our study was to assess the specifity and sensitivity of various ultrasound findings in gastroesophageal junction compared to pH monitoring.
Material and methods: 66 asthmatic children aged 38-206 months (mean 122.8±44.89 mo.) were examined. Ultrasonography of gastroesophageal junction, 24-hour pH monitoring, questionnaire-based survey concerning: clinical symptoms, atopy, asthma severity, treatment were done.
Results: 35 children (53%) had abnormal results of pH monitoring. Ultrasound revealed gastroesophageal reflux episodes in 26 (39.4%). "Beak symptom" was present also in 26 children (39.4%). Wide His angle was found in 53 patients(80.3%). Mean length of intra-abdominal part of esophagus (EL) was 18.71 ±10.07 mm (0-35 mm). Only ELcorrelated well with increased pH<4 ratio (Pearson p<0.03). Neither of three other ultrasound symptoms has predicted abnormal pH-metry with great accuracy. No one ultrasound symptom correlated significantly with the presence of nocturnal reflux episodes in pH monitoring.
Conclusions: Ultrasonography of gastroesophageal junction in children with bronchial asthma can reveal a lot of abnormalities in the structure and function of cardia, but the diagnostic effectiveness compared to pH monitoring is poor. Only the shortening of intra-abdominal part of esophagus seems to be important finding in diagnosing GER in children.