Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
권호 표지
DOI QR코드

DOI QR Code

Association Between Pediatric Gastroesophageal Reflux Disease Symptom and Quality of Life Questionnaire Score, Endoscopy and Biopsy in Children with Clinical Gastroesophageal Reflux Disease: A Prospective Study

  • Fatima Safira Alatas (Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusomo Hospital) ;
  • Dian Wulandaru Sukmaning Pertiwi (Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusomo Hospital) ;
  • Muzal Kadim (Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusomo Hospital) ;
  • Pramita Dwipoerwantoro (Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusomo Hospital) ;
  • Hanifah Oswari (Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusomo Hospital) ;
  • Badriul Hegar (Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusomo Hospital) ;
  • Yvan Vandenplas (Vrije Universiteit Brussel)
  • Received : 2022.11.09
  • Accepted : 2023.05.10
  • Published : 2023.07.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Gastro esophageal reflux disease (GERD) is a burdensome disease affecting many children. A clinical examination is reported to be unreliable to diagnose GERD in children. This study aimed to investigate the relationship between the Pediatric Gastroesophageal Reflux Disease Symptom and Quality of Life Questionnaire (PGSQ) and endoscopic and histopathological findings in children with symptoms suggesting GERD. Changes in the PGSQ score in children with esophagitis as response to one month therapy were recorded as secondary outcome. Methods: This is a prospective cohort study in the pediatric outpatient clinic in an Indonesian tertiary hospital. Children aged 2-17 years old with clinical symptoms suspected of GERD are included in the study. Blinded endoscopic and histopathological examination was performed in all patients before one month proton pump inhibitors (PPI) therapy. The PGSQ information was collected at inclusion and after one month PPI treatment. Results: Fifty-eight subjects were included. Esophagitis was found in 60.9% of subjects according to endoscopy and 58.6% according to histology. There was no significant relationship between the PGSQ score and endoscopic (p=0.781) nor biopsy (p=0.740) examinations. The PGSQ showed a low diagnostic value compared to endoscopy and biopsy (area under the curve [AUC] 0.477, p=0.477, 95% confidence interval [CI] 0.326-0.629 and AUC 0.474, p=0.740 (95% CI 0.321-0.627 respectively). The PGSQ improved significantly post one month of PPI treatment. Conclusion: The PGSQ cannot be used to diagnose esophagitis in children with clinical symptoms suggesting GERD. However, the PGSQ can be used to monitor the treatment response in children with esophagitis.

Keywords

References

  1. Omari TI, Barnett CP, Benninga MA, Lontis R, Goodchild L, Haslam RR, et al. Mechanisms of gastro-oesophageal reflux in preterm and term infants with reflux disease. Gut 2002;51:475-9. https://doi.org/10.1136/gut.51.4.475
  2. Vandenplas Y. Reflux esophagitis in infants and chidren: a report from the working group on gastroesophageal disease of the European Society of Paediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr 1994;18:413-22. https://doi.org/10.1097/00005176-199405000-00001
  3. Black DD, Haggitt RC, Orenstein SR, Whitington PF. Esophagitis in infants. Morphometric histological diagnosis and correlation with measures of gastroesophageal reflux. Gastroenterology 1990;98:1408-14. https://doi.org/10.1016/0016-5085(90)91069-I
  4. Nelson SP, Chen EH, Syniar GM, Kaufer Christoffel K. Prevalence of symptoms of gastroesophageal reflux during childhood: A pediatric practice-based survey. Arch Pediatr Adolesc Med 2000;154:150-4. https://doi.org/10.1001/archpedi.154.2.150
  5. Mulyani L, Hegar B, Tumbelaka AR, Krisnuhoni E. Reflux esofagitis in children with feeding problems: A preliminary study. Paediatri Indones 2010;50:284-90. CROSSREF  https://doi.org/10.14238/pi50.5.2010.284-90
  6. Dadhick SK, Yachha SK, Srivastava A, Sikora SS, Pandey R. Endoscopic and histologic evaluation of reflux esophagitis. Indian Pediatr 2000;37:1111-4.
  7. Salvatore S, Vandenplas Y. Gastro-esophageal reflux disease and motility disorder. Best Pract Res Clin Gastroenterol 2003;17:163-79. https://doi.org/10.1016/S1521-6918(02)00146-4
  8. El-Serag HB, Bailey NR, Gilger M, Rabeneck L. Endoscopic manifestation of gastroesophageal reflux disease in patients between 18 months and 25 years without neurological deficits. Am J Gastroenterol 2002;97:1635-9. https://doi.org/10.1111/j.1572-0241.2002.05820.x
  9. Salvatore S, Hauser B, Vandenplas Y. The natural course of gastro-esophageal reflux. Acta Paediatr 2004;93:1063-9. https://doi.org/10.1111/j.1651-2227.2004.tb02719.x
  10. Vandenplas Y, Salvatore S, Hauser B. The diagnosis and management of gastro-esophageal reflux in infants. Early Hum Dev 2005;81:1011-24. https://doi.org/10.1016/j.earlhumdev.2005.10.011
  11. Rosen R, Vandenplas Y, Singendonk M, Cabana M, Dilorenzo C, Gottrand F, et al. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 2018;66:516-54. https://doi.org/10.1097/MPG.0000000000001889
  12. Rybak A, Pesce M, Thapar N, Borrelli O. Gastro-esophageal reflux in children. Int J Mol Sci 2017;18:1671.
  13. Salvatore S, Hauser B, Vandemaele K, Novario R, Vandenplas Y. Gastroesophageal reflux disease in infants: How much is predictable with questionnaires, pH-metry, eodoscopy and histology? J Pediatr Gastroenterol Nutr 2005;40:210-5. https://doi.org/10.1097/00005176-200502000-00024
  14. Kleinman L, Nelson S, Kothari-Talwar S, Roberts L, Orenstein S, Mody R, et al. Development and psychometric evaluation of 2 age-stratified versions of the pediatric GERD Symptom and Quality of Life Questionnaire. J Pediatr Gastroenterol Nutr 2011;52:514-22. https://doi.org/10.1097/MPG.0b013e318205970e
  15. Artanti D, Hegar B, Kaswandani N, Soedjatmiko , Prayitno A, Devaera Y, et al. The gastroesophageal reflux disease questionnaire in adolescents: What is the best cutoff score? Pediatr Gastroenterol Hepatol Nutr 2019;22:341-9. https://doi.org/10.5223/pghn.2019.22.4.341
  16. Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Galmiche JP, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut 1999;45:172-80. https://doi.org/10.1136/gut.45.2.172
  17. Shub MD, Ulshen MH, Hargrove CB, Siegal GP, Groben PA, Askin FB. Esophagitis: A frequent consequence of gastroesophageal reflux in infancy. J Pediatr 1985;107:881-4. https://doi.org/10.1016/S0022-3476(85)80180-3
  18. Leape LL, Bhan I, Ramenofsky ML. Esophageal biopsy in the diagnosis of reflux esophagitis. J Pediatr Surg 1981;16:379-84. https://doi.org/10.1016/S0022-3468(81)80699-9
  19. Genta RM, Spechler SJ, Kielhorn AF. The Los Angeles and Savary-Miller systems for grading esophagitis: Utilization and correlation with histology. Dis Esophagus 2011;24:10-7. https://doi.org/10.1111/j.1442-2050.2010.01092.x
  20. Shaw M, Dent J, Beebe T, Junghard O, Wiklund I, Lind T, et al. The reflux disease questionnaire: A measure for assessment of treatment response in clinical trials. Health Qual Life Outcomes 2008;6:1-6. https://doi.org/10.1186/1477-7525-6-1