Prospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Jun 9, 2023; 12(3): 151-161
Published online Jun 9, 2023. doi: 10.5409/wjcp.v12.i3.151
Prevalence of gastroesophageal reflux disease in children with extraesophageal manifestations using combined-video, multichannel intraluminal impedance-pH study
Sutha Eiamkulbutr, Termpong Dumrisilp, Anapat Sanpavat, Palittiya Sintusek
Sutha Eiamkulbutr, Department of Pediatrics, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
Termpong Dumrisilp, Department of Pediatrics, Bhumibol Adulyadej Hospital, Bangkok 10220, Thailand
Anapat Sanpavat, Department of Pathology, Chulalongkorn University, Bangkok 10330, Thailand
Palittiya Sintusek, Thai Pediatric Gastroenterology, Hepatology and Immunology Research Unit, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Author contributions: Eiamkulbutr S, Dumrisilp T and Sintusek P performed the upper endoscopy and MII-pH study; Eiamkulbutr S, Dumrisilp T collected all the data; Sanpavat A analyzed and interpreted the histopathological data; Eiamkulbutr S recorded all symptoms from video recording; Eiamkulbutr S and Sintusek P analyzed and interpreted the MII-pH study and wrote the manuscript; Sintusek P was responsible for designing, editing, and revising the manuscript; Sintusek P edited the intellectual content in the manuscript; all approved for the final version of the manuscript.
Supported by The Ratchadapiseksompotch Fund, Chulalongkorn University's Faculty of Medicine, King Chulalongkorn Memorial Hospital's Department of Pediatrics, and Chulalongkorn University's Faculty of Medicine (GA64/48).
Institutional review board statement: The study was reviewed and approved by the Chulalongkorn University Institutional Review Board approved this study (IRB 029/64).
Clinical trial registration statement: This study is registered at https://www.thaiclinicaltrials.org/show/TCTR20210829001. The registration identification number is TCTR20210829001.
Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this manuscript having no conflict of interest to disclose.
Data sharing statement: Data will be shared when investigators contact the corresponding author.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Palittiya Sintusek, MD, PhD, Associate Professor, Thai Pediatric Gastroenterology, Hepatology and Immunology Research Unit, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok 10330, Thailand. palittiya.s@chula.ac.th
Received: February 20, 2023
Peer-review started: February 20, 2023
First decision: April 8, 2023
Revised: April 13, 2023
Accepted: May 6, 2023
Article in press: May 6, 2023
Published online: June 9, 2023
ARTICLE HIGHLIGHTS
Research background

Gastroesophageal reflux disease (GERD) might be either a cause or comorbidity in children with extraesophageal problems especially as refractory respiratory symptoms, without any best methods or criterion for diagnosing it in children.

Research motivation

Recent studies in adults also propose that additional parameters from the multichannel intraluminal impedance (MII)-pH study, mean nocturnal baseline impedance (MNBI), and post-reflux swallow-induced peristaltic wave, increase the diagnostic value of this tool. However, there has been scarce evidence to support the best method for diagnosing extraesophageal GERD in children.

Research objectives

To study the prevalence of extraesophageal GERD, especially in children who presented with refractory respiratory problems by using combined video-MII-pH study. Furthermore, to identify other parameters from MII-pH study that can help the diagnosis of extraesophageal GERD.

Research methods

Children with respiratory symptoms and other extraesophageal manifestations suggestive of GERD were enrolled to participate in the present study. MII-pH study and/or video monitoring and/or upper endoscopy with esophageal histopathology were performed. The prevalence of extraesophageal GERD and the novel diagnostic parameters to diagnose extraesophageal GERD were analyzed.

Research results

The prevalence of extraesophageal GERD was 35.3% by using the MII-pH study and 31.4% of children who had extraesophageal manifestations of GERD also had gastrointestinal symptoms. Total symptom record, longest reflux time (LRT), and MNBI were the parameters that were significantly different between the GERD and non-GERD groups. LRT and MNBI were the independent parameters from multivariable analysis. Using video monitoring during MII-pH study to depict more symptom record increases the diagnostic yield of extraesophageal GERD.

Research conclusions

In conclusion, the prevalence of GERD was not as high as expected. Employing video monitoring into conventional MII-pH study increases the diagnostic yield of symptom indices. LRT and MNBI are novel parameters that should be integrated into the diagnostic criteria for GERD.

Research perspectives

The diagnostic test for extraesophageal GERD in children is limited and there have been a few data support the favorable treatment outcome in these children. Hence, the extensive investigations in these difficult cases are needed and other mimic causes should be ruled out. Further study in aspect of esophageal manometry combined with video-MII-pH study and histopathology in various presentations of GERD should be initiated to extend the knowledge about the pathogenesis of GERD and hopefully, could tailor therapy for these patients.