Reliability Of Different Endoscopic Classification Systems In Predicting Pediatric Reflux Esophagitis

Year 2019, Volume: 7 Issue: Ek - IRUPEC 2019 Kongresi Tam Metin Bildirileri, 280 - 284, 10.12.2019

Halil Haldun Emiroğlu Özlem Durmaz Semra Sökücü"

Abstract

Aim: Retrospective in nature, this study was aimed at evaluating the reliability of four endoscopic classification systems in predicting histological reflux esophagitis in children undergoing esophagogastroduedenoscopy.
Materials and Methods: This retrospective study included 213 children (112 male, 101 female, average age 8.4 ± 4.8 years, median age 9 years, range 2 months–18 years) who underwent diagnostic esophagogastroduodenoscopy between January 2002 and December 2004 and evaluated for the presence of reflux esophagitis. Data for age and gender, and detailed endoscopic and histopathological reports were retrieved from medical records. Los Angeles, Savary-Miller, Hetzel-Dent, and Tytgat endoscopic classification systems were used in the evaluation of patients with erosive distal esophagitis. The histological findings were classified according to Knuff & Leape. When reflux-related esophageal damage was identified as a result of the histological examination of endoscopic biopsy samples collected from distal esophagus, the patients were diagnosed with reflux esophagitis. The Statistical Package for the Social Sciences for Windows Release 12.0 (SPSS, Chicago, IL, USA) was used to analyse the statistical data.

Results:
On the histological examination of esophageal mucosal biopsy specimens of 213 patients, 71 (33.3%) patients had normal (grade 0), 75 (35.2%) patients with only histologic changes of reflux (grade 1) without esophagitis and 67 (31.5%) patients were reflux esophagitis (grade 2–5) were detected. There were 49 (23%) patients with mild esophagitis (grade 2), 6 (3%) patients with moderate esophagitis (grade 3) and 12 (6%) patients with severe esophagitis 2 (1%) patients with grade 4 and 10 (5%) patients with grade 5) in 67 patients with reflux esophagitis.
On the endoscopical examination of esophageal mucosal appearances of 213 patients, 36 (16.9%) patients, 36 (16.9%) patients, 100 (46.9%) patients and 90 (42.3%) patients were diagnosed with esophagitis according to the Los Angeles, Savary-Miller, Hetzel-Dent and Tytgat endoscopic classification systems, respectively. When the four different endoscopic classification systems evaluated in terms of score correlation with the histological diagnosis, the most linear relationship was found between LA endoscopic classification and Knuff & Leape histological classification (r = 0.544, p <0.01).

Conclusion:
No significant strong association in the prevalence of reflux esophagitis between the endoscopic classification systems and Knuff & Leape histological classification. The Los Angeles endoscopic classification more compatible with Knuff & Leape histological classification than other endoscopic classification systems. Though not so safe, the Los Angeles endoscopic classification can be recommended in children as in adults.

Keywords

Gastroesophageal reflux disease

References

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