Ultraschall Med 2005; 26 - OP150
DOI: 10.1055/s-2005-917431

WHY DON'T WE USE SONOGRAPHY BY CHILDREN WITH GASTROESOPHAGEAL REFLUX? THE ULTRASONOGRAPHIC FEATURES OF GASTROESOPHAGEAL REFLUX BY CHILDREN

R Jaworski 1, D Swieton 2, W Kosiak 2, N Irga 3
  • 1Students Scientific Ultrasonography Group, Dept. Pediatric Nephrology, Medical University
  • 2Dept. Pediatric Nephrology
  • 3Dept. of Pediatric, Hematology, Oncology and Endocrinology, Medical University of Gdansk, Gdansk, Poland

Purpose: Because sonography of the gastroesophageal junction is not common diagnostic method of gastroesophageal reflux (GER) and many guidelines for the management of pediatric GER do not even include this kind of examination. The aim of this study was to determine usefulness of sonography in GER diagnostic in patients with clinical symptoms suggesting GER.

Methods and Materials: In this prospective study, we examined sonographic 50 children (28 boys, 22 girls) aged 4 months to 14 years (mean 33 months). All children had recurrent respiratory infections; we chose them because recurrent respiratory infections are one of GER symptoms. For visualization of the stomach cardia and the subdiaphragmatic part of the esophagus the transducer was placed in the midline below xiphoid. Through the window of the left lobe of the liver we described the length of the abdominal part of esophagus, the His ankle, and the presence of the passage of gastric fluid into the abdominal esophagus (GER). In the group of children with GER the follow-up examination after two months treatment (cisapride) has taken place and the results were compared. All procedures were taken with institutional ethics committee approval by students under clinicians' control.

Results: The gastroesophageal junction was identified by ultrasonography in all 50 children. On the first sonography, 37/50 patients (74%) had GER, in 62% in this group the His ankle was obtuse and the median subdiaphragmatic esophagus length was 13,4mm, mean 13,6mm (SE 0,6mm). In non-GER children group the His ankle in 30% was obtuse and the median length of subdiaphragmatic part of the esophagus was 18,3mm, mean 17mm (SE 1,4mm).There was significant difference between the length of subdiaphragmatic part of the esophagus in both groups (p<0.05). 18 of 37 children with GER took part in follow-up study. In 6/18 (33%) patients there wasn't GER in the second sonography examination, in 12/18 (67%) there was GER constantly, however not as intensive as in the first one. In the follow-up group the subdiaphragmatic esophagus length and the His ankle were similar to GER-positive group in the first examination, however in parents opinion the clinical GER symptoms has reduced.

Conclusions:

  • Transabdominal sonography of the gastroesophageal junction is in our opinion a useful method in GER diagnostic in children

  • The features as obtuse His ankle, short length of subdiaphragmatic part of the esophagus and especially the presence of the passage of gastric fluid into the abdominal esophagus should be taken into consideration as characteristic features of GER

  • We don't know why clinicians don't use sonography in GER diagnostic. It seems: as a noninvasive, simple, informative, quick, repetitive and safe method, providing morphologic and functional information, ultrasonography should be a gold standard in diagnostic of pediatric GER, especially when GER symptoms are observed. We think, this method as a simple and useful tool should be promoted and employed in every situation in pediatric practice when GER is supposed.