Prospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Jun 9, 2023; 12(3): 151-161
Published online Jun 9, 2023. doi: 10.5409/wjcp.v12.i3.151
Prevalence of gastroesophageal reflux disease in children with extraesophageal manifestations using combined-video, multichannel intraluminal impedance-pH study
Sutha Eiamkulbutr, Termpong Dumrisilp, Anapat Sanpavat, Palittiya Sintusek
Sutha Eiamkulbutr, Department of Pediatrics, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
Termpong Dumrisilp, Department of Pediatrics, Bhumibol Adulyadej Hospital, Bangkok 10220, Thailand
Anapat Sanpavat, Department of Pathology, Chulalongkorn University, Bangkok 10330, Thailand
Palittiya Sintusek, Thai Pediatric Gastroenterology, Hepatology and Immunology Research Unit, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Author contributions: Eiamkulbutr S, Dumrisilp T and Sintusek P performed the upper endoscopy and MII-pH study; Eiamkulbutr S, Dumrisilp T collected all the data; Sanpavat A analyzed and interpreted the histopathological data; Eiamkulbutr S recorded all symptoms from video recording; Eiamkulbutr S and Sintusek P analyzed and interpreted the MII-pH study and wrote the manuscript; Sintusek P was responsible for designing, editing, and revising the manuscript; Sintusek P edited the intellectual content in the manuscript; all approved for the final version of the manuscript.
Supported by The Ratchadapiseksompotch Fund, Chulalongkorn University's Faculty of Medicine, King Chulalongkorn Memorial Hospital's Department of Pediatrics, and Chulalongkorn University's Faculty of Medicine (GA64/48).
Institutional review board statement: The study was reviewed and approved by the Chulalongkorn University Institutional Review Board approved this study (IRB 029/64).
Clinical trial registration statement: This study is registered at https://www.thaiclinicaltrials.org/show/TCTR20210829001. The registration identification number is TCTR20210829001.
Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this manuscript having no conflict of interest to disclose.
Data sharing statement: Data will be shared when investigators contact the corresponding author.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Palittiya Sintusek, MD, PhD, Associate Professor, Thai Pediatric Gastroenterology, Hepatology and Immunology Research Unit, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok 10330, Thailand. palittiya.s@chula.ac.th
Received: February 20, 2023
Peer-review started: February 20, 2023
First decision: April 8, 2023
Revised: April 13, 2023
Accepted: May 6, 2023
Article in press: May 6, 2023
Published online: June 9, 2023
Processing time: 107 Days and 16.2 Hours
Abstract
BACKGROUND

Gastroesophageal reflux disease (GERD) might be either a cause or comorbidity in children with extraesophageal problems especially as refractory respiratory symptoms, without any best methods or criterion for diagnosing it in children.

AIM

To evaluate the prevalence of extraesophageal GERD using conventional and combined-video, multichannel intraluminal impedance-pH (MII-pH), and to propose novel diagnostic parameters.

METHODS

The study was conducted among children suspected of extraesophageal GERD at King Chulalongkorn Memorial Hospital between 2019 and 2022. The children underwent conventional and/or combined-video MII-pH. The potential parameters were assessed and receiver operating characteristic was used for the significant parameters.

RESULTS

Of 51 patients (52.9% males), aged 2.24 years were recruited. The common problems were cough, recurrent pneumonia, and hypersecretion. Using MII-pH, 35.3% of the children were diagnosed with GERD by reflux index (31.4%), total reflux events (3.9%), and symptom indices (9.8%) with higher symptom recorded in the GERD group (94 vs 171, P = 0.033). In the video monitoring group (n = 17), there were more symptoms recorded (120 vs 220, P = 0.062) and more GERD (11.8% vs 29.4%, P = 0.398) by symptom indices. Longest reflux time and mean nocturnal baseline impedance were significant parameters for diagnosis with receiver operating characteristic areas of 0.907 (P = 0.001) and 0.726 (P = 0.014).

CONCLUSION

The prevalence of extraesophageal GERD in children was not high as expected. The diagnostic yield of symptom indices increased using video monitoring. Long reflux time and mean nocturnal baseline impedance are novel parameters that should be integrated into the GERD diagnostic criteria in children.

Keywords: Extraesophageal reflux; pH-impedance; Children; Gastroesophageal reflux; Mean nocturnal baseline impedance

Core Tip: This was a retrospective and cross-sectional study with 51 children suspected extraesophageal gastrointestinal esophageal reflux disease (GERD). This study found the prevalence of GERD in these pediatric patients was 35.3% by using combined-video, multichannel intraluminal impedance-pH study. Moreover, longest reflux time and mean nocturnal baseline impedance were depicted as the significant parameters for GERD diagnosis with satisfied diagnostic value in children.