Üst Gastrointestinal Sistem Floroskopi Yapılan Pediatrik Hastalarda Gastroözofageal Reflü Tanısını Etkileyen Faktörler
Abstract
Amaç: Bu
çalışmanın amacı bebeklerde ve çocuklarda üst gastrointestinal floroskopi
sonuçlarını değerlendirmek, sonuçları etkileyen faktörleri ve gastroözofageal
reflü (GÖR) tanısını araştırmaktır.
Yöntemler: Dr.
Sami Ulus Kadın Doğum, Çocuk Sağlığı ve Hastalıkları Eğitim ve Araştırma
Hastanesi Pediatrik Radyoloji Bölümü'nde 1 Ocak 2018 ile 31 Aralık 2018
tarihleri arasında üst gastrointestinal sistem floroskopisi uygulanan 1 aylık ile 18 yaş arasındaki
hastalar çalışmaya dahil edildi. Hastaların dosyaları retrospektif olarak
incelendi.
Bulgular: Üst
gastrointestinal sistem floroskopisi yapılan 76 hastanın% 46.1'i erkek, ortanca
yaşı 10 aydı. Bunların% 2.6'sına (n=2) hafif GÖR,% 18.4'ü (n=14) orta GÖR ve%
38.2'si (n=29) şiddetli GÖR tanısı konuldu. Eşlik eden anatomik patolojiler
şunlardı: malrotasyon (% 5.3), opere özofagus atrezisi ve diyafragma hernisi (%
2.6), organoaksiyel volvulus ve preplorik veb (% 1.3). Üst gastrointestinal floroskopi
istem nedenleri% 40.8 (n=31) 'de dirençli kusma,% 10.5 (n=8)' de aralıklı kusma ve% 11.8
(n=9) öksürüktü. En sık eşlik eden patolojiler % 6.6'da (n=5) prematürite ve
büyüme geriliği idi. 1 yaşından küçüklerin% 74.4'üne GÖR tanısı konulurken, bu
oran 1 yaş ve üstü çocuklarda % 39.4 idi. 1 yaşından küçük hastalarda GÖR
görülme sıklığı anlamlı derecede yüksek bulundu (p=0.002). Sürekli kusma olan
hastaların % 74.2'sinde (n=23) GÖR, diğer nedenlerle üst gastrointestinal floroskopi
uygulanan hastaların % 48.9'unda (n=22) GÖR mevcuttu. Bu fark da istatistiksel
olarak anlamlıydı (p=0.027).
Sonuç: Gastroözofageal
reflü hastalığından şüphelenilen durumlarda, hasta 1 yaşından küçükse veya
sürekli kusma varsa, üst gastrointestinal sistem floroskopisi tanıyı doğrulamak için yararlı olabilir. Bununla
birlikte, anatomik bozukluklar önerilen UGF'lerin çok azında tespit edilebilmiştir.
Bu bakış açısından, klinisyenlerin radyasyona bağlı riskler ve prosedür zorlukları göz önünde bulundurularak
UGF'yi önermeleri uygun olacaktır.
References
- 1 Lightdale JR, Gremse DA. Gastroesophageal reflux: management guidance for the pediatrician. Pediatrics 2013;131:e1684-1695.
- 2 Gupta SK, Hassall E, Chiu YL, Amer F, Heyman MB. Presenting symptoms of nonerosive and erosive esophagitis in pediatric patients. Dig Dis Sci 2006;51:858-863.
- 3 Manfredi MA. Epidemiology of gastroesophageal reflux disease. Epidemiology of gastroesophageal reflux disease, Edtion ed: Springer;2017:829-834.
- 4 Gold BD. Outcomes of pediatric gastroesophageal reflux disease: in the first year of life, in childhood, and in adults...oh, and should we really leave Helicobacter pylori alone? J Pediatr Gastroenterol Nutr 2003;37 Suppl 1:S33-39.
- 5 Dent J, El-Serag HB, Wallander MA, Johansson S. Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2005;54:710-717.
- 6 Gonzalez Ayerbe JI, Hauser B, Salvatore S, Vandenplas Y. Diagnosis and Management of Gastroesophageal Reflux Disease in Infants and Children: from Guidelines to Clinical Practice. Pediatr Gastroenterol Hepatol Nutr 2019;22:107-121.
- 7 Shaheen NJ, Falk GW, Iyer PG, Gerson LB. ACG Clinical Guideline: Diagnosis and Management of Barrett's Esophagus. Am J Gastroenterol 2016;111:30-50; quiz 51.
- 8 Rizk MK, Sawhney MS, Cohen J, Pike IM, Adler DG, Dominitz JA, et al. Quality indicators common to all GI endoscopic procedures. Am J Gastroenterol 2015;110:48-59.
- 9 Hegar B, Dewanti NR, Kadim M, Alatas S, Firmansyah A, Vandenplas Y. Natural evolution of regurgitation in healthy infants. Acta Paediatr 2009;98:1189-1193.
- 10 Orenstein SR. Infant GERD: Symptoms, Reflux Episodes & Reflux Disease, Acid & Non-acid Refllux—Implications for Treatment with PPIs. Current gastroenterology reports 2013;15:353.
- 11 Quitadamo P, Staiano A. Clinical Picture of Gastroesophageal Reflux Disease in Children. Clinical Picture of Gastroesophageal Reflux Disease in Children, Edtion ed: IntechOpen;2019.
- 12 Moore DJ, Tao BS, Lines DR, Hirte C, Heddle ML, Davidson GP. Double-blind placebo-controlled trial of omeprazole in irritable infants with gastroesophageal reflux. J Pediatr 2003;143:219-223.
- 13 Shields TM, Lightdale JR. Vomiting in Children. Pediatr Rev 2018;39:342-358.
- 14 Volonaki E, Sebire NJ, Borrelli O, Lindley KJ, Elawad M, Thapar N, et al. Gastrointestinal endoscopy and mucosal biopsy in the first year of life: indications and outcome. J Pediatr Gastroenterol Nutr 2012;55:62-65.
- 15 Sheiko MA, Feinstein JA, Capocelli KE, Kramer RE. Diagnostic yield of EGD in children: a retrospective single-center study of 1000 cases. Gastrointestinal endoscopy 2013;78:47-54.e41.
- 16 Mousa H, Hassan M. Gastroesophageal Reflux Disease. Pediatric clinics of North America 2017;64:487-505.
- 17 Størdal K, Johannesdottir GB, Bentsen BS, Sandvik L. Gastroesophageal reflux disease in children: association between symptoms and pH monitoring. Scandinavian journal of gastroenterology 2005;40:636-640.
- 18 von Baeyer CL, Spagrud LJ. Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years. Pain 2007;127:140-150.
- 19 Noble AJ, Drouin E, Tamblyn R. Design of predictive models for positive outcomes of upper and lower gastrointestinal endoscopies in children and adolescents. J Pediatr Gastroenterol Nutr 2008;46:409-413.
- 20 Thakkar K, Chen L, Tatevian N, Shulman RJ, McDuffie A, Tsou M, et al. Diagnostic yield of oesophagogastroduodenoscopy in children with abdominal pain. Aliment Pharmacol Ther 2009;30:662-669.
- 21 Poddar U. Gastroesophageal reflux disease (GERD) in children. Paediatr Int Child Health 2019;39:7-12.
- 22 Carroll MW, Jacobson K. Gastroesophageal reflux disease in children and adolescents: when and how to treat. Paediatr Drugs 2012;14:79-89.
Factors Affecting The Diagnosis Of Gastroesophageal Reflux In Pediatric Patients Undergoing Upper Gastrointestinal Fluoroscopy
Abstract
Objective:
The aim of this
study was to evaluate the results of upper gastrointestinal fluoroscopy in
infants and children and to investigate factors affecting results and the
diagnosis of gastroesophageal reflux (GER).
Material
and Methods: Patients
between the ages of 1 month and 18 years who underwent upper gastrointestinal fluoroscopy
at the Radiology Department of Dr. Sami Ulus Research and Training Hospital
between January 1, 2018 and December 31, 2018 were included in the study. The
files of the patients were reviewed retrospectively.
Results:
Of the 76 patients
who underwent upper gastrointestinal fluoroscopy, 46.1% were male and median
age was 10 months. Among these, 2.6% (n=2) were diagnosed with mild GER, 18.4%
(n=14) with moderate GER, and 38.2% (n=29) with severe GER. The accompanying
anatomic pathologies were: malrotation (5.3%), operated esophageal atresia and
diaphragmatic hernia (2.6%), organoaxial volvulus and prepyloric web (1.3%).
Reasons of requesting upper gastrointestinal fluoroscopy were persistent
vomiting in 40.8% (n=31), intermittent vomiting in 10.5% (n=8), and coughing in
11.8% (n=9). The most common accompanying pathologies were prematurity and
growth retardation in 6.6% (n=5). 74.4% of those younger than 1 year of age
were diagnosed with GER, while this percentage was 39.4% in those aged 1 year
or older. The incidence of GER in patients younger than 1 year of age was found
to be significantly higher (p=0.002). GER was present in 74.2% (n=23) of
patients who had persistent vomiting, while it was present in 48.9% (n=22) of
patients who underwent upper gastrointestinal fluoroscopy for other reasons.
This difference was also statistically significant (p=0.027).
Conclusion:
In cases where
gastroesophageal reflux disease is suspected, if the patient is younger than 1
year of age or has persistent vomiting, upper gastrointestinal fluoroscopy may
be useful to confirm the diagnosis. However, anatomical disorder can be detected in very
few of the recommended UGF. From this point of view, it would be more
appropriate for clinicians to recommend UGF in more suitable cases considering radiation
related risks and procedure
difficulties.
References
- 1 Lightdale JR, Gremse DA. Gastroesophageal reflux: management guidance for the pediatrician. Pediatrics 2013;131:e1684-1695.
- 2 Gupta SK, Hassall E, Chiu YL, Amer F, Heyman MB. Presenting symptoms of nonerosive and erosive esophagitis in pediatric patients. Dig Dis Sci 2006;51:858-863.
- 3 Manfredi MA. Epidemiology of gastroesophageal reflux disease. Epidemiology of gastroesophageal reflux disease, Edtion ed: Springer;2017:829-834.
- 4 Gold BD. Outcomes of pediatric gastroesophageal reflux disease: in the first year of life, in childhood, and in adults...oh, and should we really leave Helicobacter pylori alone? J Pediatr Gastroenterol Nutr 2003;37 Suppl 1:S33-39.
- 5 Dent J, El-Serag HB, Wallander MA, Johansson S. Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2005;54:710-717.
- 6 Gonzalez Ayerbe JI, Hauser B, Salvatore S, Vandenplas Y. Diagnosis and Management of Gastroesophageal Reflux Disease in Infants and Children: from Guidelines to Clinical Practice. Pediatr Gastroenterol Hepatol Nutr 2019;22:107-121.
- 7 Shaheen NJ, Falk GW, Iyer PG, Gerson LB. ACG Clinical Guideline: Diagnosis and Management of Barrett's Esophagus. Am J Gastroenterol 2016;111:30-50; quiz 51.
- 8 Rizk MK, Sawhney MS, Cohen J, Pike IM, Adler DG, Dominitz JA, et al. Quality indicators common to all GI endoscopic procedures. Am J Gastroenterol 2015;110:48-59.
- 9 Hegar B, Dewanti NR, Kadim M, Alatas S, Firmansyah A, Vandenplas Y. Natural evolution of regurgitation in healthy infants. Acta Paediatr 2009;98:1189-1193.
- 10 Orenstein SR. Infant GERD: Symptoms, Reflux Episodes & Reflux Disease, Acid & Non-acid Refllux—Implications for Treatment with PPIs. Current gastroenterology reports 2013;15:353.
- 11 Quitadamo P, Staiano A. Clinical Picture of Gastroesophageal Reflux Disease in Children. Clinical Picture of Gastroesophageal Reflux Disease in Children, Edtion ed: IntechOpen;2019.
- 12 Moore DJ, Tao BS, Lines DR, Hirte C, Heddle ML, Davidson GP. Double-blind placebo-controlled trial of omeprazole in irritable infants with gastroesophageal reflux. J Pediatr 2003;143:219-223.
- 13 Shields TM, Lightdale JR. Vomiting in Children. Pediatr Rev 2018;39:342-358.
- 14 Volonaki E, Sebire NJ, Borrelli O, Lindley KJ, Elawad M, Thapar N, et al. Gastrointestinal endoscopy and mucosal biopsy in the first year of life: indications and outcome. J Pediatr Gastroenterol Nutr 2012;55:62-65.
- 15 Sheiko MA, Feinstein JA, Capocelli KE, Kramer RE. Diagnostic yield of EGD in children: a retrospective single-center study of 1000 cases. Gastrointestinal endoscopy 2013;78:47-54.e41.
- 16 Mousa H, Hassan M. Gastroesophageal Reflux Disease. Pediatric clinics of North America 2017;64:487-505.
- 17 Størdal K, Johannesdottir GB, Bentsen BS, Sandvik L. Gastroesophageal reflux disease in children: association between symptoms and pH monitoring. Scandinavian journal of gastroenterology 2005;40:636-640.
- 18 von Baeyer CL, Spagrud LJ. Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years. Pain 2007;127:140-150.
- 19 Noble AJ, Drouin E, Tamblyn R. Design of predictive models for positive outcomes of upper and lower gastrointestinal endoscopies in children and adolescents. J Pediatr Gastroenterol Nutr 2008;46:409-413.
- 20 Thakkar K, Chen L, Tatevian N, Shulman RJ, McDuffie A, Tsou M, et al. Diagnostic yield of oesophagogastroduodenoscopy in children with abdominal pain. Aliment Pharmacol Ther 2009;30:662-669.
- 21 Poddar U. Gastroesophageal reflux disease (GERD) in children. Paediatr Int Child Health 2019;39:7-12.
- 22 Carroll MW, Jacobson K. Gastroesophageal reflux disease in children and adolescents: when and how to treat. Paediatr Drugs 2012;14:79-89.
Details
| Primary Language | English |
|---|---|
| Subjects | Internal Diseases |
| Journal Section | ORIGINAL ARTICLES |
| Authors | |
| Publication Date | May 29, 2020 |
| Submission Date | January 13, 2020 |
| Published in Issue | Year 2020 Volume: 14 Issue: 3 |
The publication language of Turkish Journal of Pediatric Disease is English.
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