The role of a contrast study in the investigation of Paediatric Gastroesophageal Reflux disease.

Abstract

Background: Gastroesophageal reflux (GER) is a common finding in the pediatric population. This can either be physiological re flux or established disease that may require surgical intervention. There is currently no consensus on a gold standard in the diagnosis of gastroesophageal reflux disease (GERD). The purpose of this article is to describe the role of contrast radiography in this process, looking in particular at the subset of neurologically impaired (NI) children. Methods: A retrospective chart review of children admitted for the work-up of GER or for gastronomy insertion, to the Department of Paediatric Surgery at Inkosi Albert Luthuli Central Hospital (IALCH) from January 2014-December 2015. Results: 42 patients (25 male, 17 female) were admitted during this period. 27(64%) were neurologically impaired. All patients had a contrast study performed. Twenty (48%) contrast studies showed GER. Twenty-two (52%) studies were negative for GER and these children subsequently had oesophageal pH monitoring studies performed. Twelve (55%) pH monitoring studies were positive for GER. Ten (45%) pH studies were negative for GER. The sensitivity of a contrast study to show GER was 62.5%. Anatomical anomalies diagnosed on contrast radiography were hiatal hernias (3), oesophageal strictures (2), situs inversus (1) and pylorospasm (1). Conclusions: Contrast radiography has a low sensitivity in diagnosing GER and adjuvant studies are sometimes necessary. However, it is useful in recognising anatomical anomalies that either predispose to GER or is a consequence of GER. It is a particularly helpful diagnostic tool in the management of neurologically impaired children who require feeding gastrostomy tubes.