Diagnosis of gastro-oesophageal reflux in children. Comparison between oesophageal pH and barium examinations

Background. Gastro-oesophageal reflux (GOR) is a common disorder encountered during childhood. Early diagnosis and treatment is essential to prevent serious complications. There are several methods for the diagnosis of GOR, with variable opinions regarding which one is the most sensitive and specific. Objective. This is a retrospective study comparing 24-h oesophageal pH monitoring and barium examinations in the diagnosis of GOR in children. Patients and methods. All children referred with signs and/or symptoms of GOR from January to December 1996 at Great Ormond Street Hospital, London, UK, were included in the study. The recorded results (presence or absence of reflux) of barium examinations and 24-h oesophageal pH monitoring studies performed on 169 children were retrospectively reviewed and compared. Results. One-third of patients were below 1 year of age. In all age groups, oesophageal pH probe studies showed a high detection rate (83%) and low incidence of false-negative results (7%) compared to barium examinations, which showed a lower detection rate (43%) and higher incidence of false-negative results (48%). Most GOR-related anatomical abnormalities diagnosed by barium examinations were identified in infants below 1 year of age. Conclusions. We believe that 24-h oesophageal pH monitoring should be used as the first line of investigation for the diagnosis of GOR in all children regardless of the age group. Barium examinations can be reserved for patients below 1 year of age, those going for surgery and those with negative oesophageal pH monitoring results but strong clinical suspicion of GOR.