Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
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Is the Diagnostic Trial with Proton Pump Inhibitors Reasonable for School Age Children with Gastroesophageal Reflux Symptoms?

  • Yang, Jaeeun (Department of Pediatrics, Jeju National University School of Medicine) ;
  • Lee, Jieon (Department of Pediatrics, Jeju National University School of Medicine) ;
  • Lee, Hyunju (Department of Pediatrics, Jeju National University School of Medicine) ;
  • Lee, Juyeon (Department of Pediatrics, Jeju National University School of Medicine) ;
  • Youn, Young Mee (Department of Pediatrics, Jeju National University School of Medicine) ;
  • Choi, Jae Hong (Department of Pediatrics, Jeju National University School of Medicine) ;
  • Kim, Yoon-Joo (Department of Pediatrics, Jeju National University School of Medicine) ;
  • Kang, Hyun Sik (Department of Pediatrics, Jeju National University School of Medicine) ;
  • Han, Kyoung Hee (Department of Pediatrics, Jeju National University School of Medicine) ;
  • Kim, Seung Hyo (Department of Pediatrics, Jeju National University School of Medicine) ;
  • Kang, Ki-Soo (Department of Pediatrics, Jeju National University School of Medicine)
  • Received : 2019.05.19
  • Accepted : 2019.09.30
  • Published : 2019.11.15
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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%${\leq}$ RI <10%), or abnormal (RI ${\geq}$10%) groups. Results: Fifty six were female and 29 were male. Their mean age was $12.6{\pm}0.5$ (${\pm}$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 $5.93{\pm}4.65$, $14.68{\pm}7.86$ and $40.37{\pm}12.96$ for the normal, intermediate and abnormal group, respectively (p=0.001). The longest reflux time was $5.56{\pm}6.00$ minutes, $9.53{\pm}7.84$ minutes, and $19.46{\pm}8.35$ 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.

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