Pediatr Gastroenterol Hepatol Nutr.  2019 Nov;22(6):511-517. 10.5223/pghn.2019.22.6.511.

Is the Diagnostic Trial with Proton Pump Inhibitors Reasonable for School Age Children with Gastroesophageal Reflux Symptoms?

Affiliations
  • 1Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea. kskang@jejunu.ac.kr

Abstract

PURPOSE
On the basis of evidence, we aimed to reevaluate the necessity of the empirical proton pump inhibitor (PPI) trial for children with suspected gastroesophageal reflux disease (GERD).
METHODS
We analyzed the frequency of GERD in 85 school-age children with gastroesophageal reflux (GER) symptoms, who received 24-hour esophageal pH monitoring and/or upper endoscopy. According to the reflux index (RI), the children were classified into normal (RI <5%), intermediate (5%≤ RI <10%), or abnormal (RI ≥10%) groups.
RESULTS
Fifty six were female and 29 were male. Their mean age was 12.6±0.5 (±standard deviation) years (range: 6.8-18.6). The RI analysis showed that the normal group included 76 patients (89.4%), the intermediate group included 6 patients (7.1%), and the abnormal group included 3 patients (3.5%). The DeMeester score was 5.93±4.65, 14.68±7.86 and 40.37±12.96 for the normal, intermediate and abnormal group, respectively (p=0.001). The longest reflux time was 5.56±6.00 minutes, 9.53±7.84 minutes, and 19.46±8.35 minutes in the normal, intermediate, and abnormal group, respectively (p=0.031). Endoscopic findings showed reflux esophagitis in 7 patients. On the basis of the Los Angeles Classification of Esophagitis, 5 of these patients were included in group A, 1 patient, in group B and 1 patient, in group C.
CONCLUSION
The incidence of GERD was very low in school-age children with GER symptoms. Therefore, injudicious diagnostic PPI trials would be postponed until the actual prevalence of GERD is verified in future prospective studies.

Keyword

Gastroesophageal reflux; Proton pump inhibitor; Child; Empirical

MeSH Terms

Child*
Classification
Endoscopy
Esophageal pH Monitoring
Esophagitis
Esophagitis, Peptic
Female
Gastroesophageal Reflux*
Humans
Incidence
Male
Prevalence
Prospective Studies
Proton Pump Inhibitors*
Proton Pumps*
Protons*
Proton Pump Inhibitors
Proton Pumps
Protons

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