Archives of disease in childhood · 2026
Diagnostic value of barium oesophagram compared to pH-impedance monitoring in the detection of paediatric gastro-oesophageal reflux.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Davis Trevor A, Rogers Benjamin D, Bhardwaj Richa, Gyawali C Prakash
Аннотация
OBJECTIVE: Gastro-oesophageal reflux (GER) is often reported on barium swallow studies. Our aim was to investigate whether GER on barium oesophagography (GERB) correlates with GER on pH-impedance monitoring (GERpH).
DESIGN: Children who underwent both pH-impedance monitoring and barium studies between 2018 and 2022 were retrospectively identified at a high-volume tertiary paediatric hospital. All pH-impedance studies were independently reanalysed to extract acid exposure time (AET), number of reflux episodes, proximal reflux episodes, reflux-symptom association and mean nocturnal baseline impedance (MNBI). GERpH was diagnosed based on the Lyon Consensus 2.0 criteria and compared with GERB.
RESULTS: Within the study timeframe, 90 children (median age 10 years (IQR 4-15 years), 56.7% female, median body mass index 17.6 kg/m2) fulfilled inclusion criteria. Overall, GERpH was seen in 20 patients (22.2%) and GERB in 38 (42.2%) patients, with no differences whether testing was performed off (26.2% vs 38.1%, respectively, p=0.491) or on (18.8% vs 45.8%, respectively, p=0.716) acid suppressive therapy. Neither conclusive GERpH nor individual reflux metrics were associated with GERB (p≥0.157 vs no GERB). 10 patients had hiatal hernia (HH), of which nine (90%) had GERB (p=0.002 compared with no HH); four of these also had GERpH with 72 (IQR 37-92) reflux episodes compared with 68 (IQR 35-98) without HH (p=0.314). In fact, HH was associated with GERB only when GERpH was negative.
CONCLUSIONS: In a symptomatic paediatric cohort evaluated for reflux symptoms, GERB does not associate with objective pathological reflux. Barium studies cannot be substituted for oesophageal testing with endoscopy and/or ambulatory reflux monitoring for objective GERD diagnosis.
DESIGN: Children who underwent both pH-impedance monitoring and barium studies between 2018 and 2022 were retrospectively identified at a high-volume tertiary paediatric hospital. All pH-impedance studies were independently reanalysed to extract acid exposure time (AET), number of reflux episodes, proximal reflux episodes, reflux-symptom association and mean nocturnal baseline impedance (MNBI). GERpH was diagnosed based on the Lyon Consensus 2.0 criteria and compared with GERB.
RESULTS: Within the study timeframe, 90 children (median age 10 years (IQR 4-15 years), 56.7% female, median body mass index 17.6 kg/m2) fulfilled inclusion criteria. Overall, GERpH was seen in 20 patients (22.2%) and GERB in 38 (42.2%) patients, with no differences whether testing was performed off (26.2% vs 38.1%, respectively, p=0.491) or on (18.8% vs 45.8%, respectively, p=0.716) acid suppressive therapy. Neither conclusive GERpH nor individual reflux metrics were associated with GERB (p≥0.157 vs no GERB). 10 patients had hiatal hernia (HH), of which nine (90%) had GERB (p=0.002 compared with no HH); four of these also had GERpH with 72 (IQR 37-92) reflux episodes compared with 68 (IQR 35-98) without HH (p=0.314). In fact, HH was associated with GERB only when GERpH was negative.
CONCLUSIONS: In a symptomatic paediatric cohort evaluated for reflux symptoms, GERB does not associate with objective pathological reflux. Barium studies cannot be substituted for oesophageal testing with endoscopy and/or ambulatory reflux monitoring for objective GERD diagnosis.