Title: Comparative assessment of diagnostic methods used in the evaluation of gastroesophageal reflux in children
- Janusz Semeniuk, Maciej Kaczmarski, Jolanta Wasilewska, Irena Białokoz, Aleksander Krasnow
- Original articles
- Polish Gastroenterology
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- Final page:
- gastroesophageal reflux (GER), 24-hour esophageal pH monitoring, barium esophagogram, GER provocative manoeuvers
Background: Continuous 24-hour esophageal pH monitoring is generally considered as the most sensitive diagnostic test fot the gastroesophageal reflux (GER) confirmation. A lot of controversy still remains as far as the role of barium esophagogram in GER diagnosis is concerned, despite its long duration of applying. Aim of the study: The aim of the study the assessment of the usefulness and accurracy of radiological method with barium and its comparative evaluation to 24-hour esophageal pH monitoring in GER diagnosis. Materiał and methods: We examined 117 children, both sexes, aged 3 to 15 years (mean age - 8.7 years) with varied clinical presentation of GER symptoms.
Results: The positive radiological findings were documented in 26% of the investigated children, in whom si-multaneously GER was confirmed in continuous 24-hour esophageal pH monitoring. The application of GER provocative manoeuvers (water-siphon test, change of the position) improved the sensitivity of GER diagnosis in radiological method to 70% and its positive predictide value to 80%. In 5 patients with GER clinical manifestation, barium esophagogram showed the presence of GER, while it was not confirmed by continuous 24-hour esophageal pH monitoring. The significant higher percentage of pH duration below 4.0 in position was found in patients with positive GER radiological findings (9.8±1.2%) comparing to the patients with negative radiological results (7.0±0.9%) (p=0.2).
Conclusions: The upper gastrointestinal X-ray with barium can not be treated as the screening test in children with clinical symptoms suggesting GER because of its episode character and the lack of ability to estimate the time of reflux duration and numbers of reflux episodes. Additionally the conditions of this investigation due to reflux provocative manoeuvres are not physiological and they can cause falsely positive results.