Diagnostic Value of Ultrasonography and Barium Meal Compared with Standard pH-Metry in Children Suspected for Gastroesophageal Reflux

Abstract

Background: Gastroesophageal reflux (GER), defined as passage of gastric contents into the esophagus, and GER disease (GERD), defined as symptoms or complications of GER, are common pediatric problems. The value of commonly used diagnostic tests for GER is examined to define the most sensitive and specific test that is the least invasive as well.

Materials and Methods: We conducted this cross sectional prospective study to compare the accuracy of barium meal (BM) and sonography (US) in diagnosing GER with the gold standard test, PH monitoring (pH-m). Fifty children (1 mo- 15 yr) with GERD symptoms were enrolled. After filling the informed by their parents, BM, US and 24 hr PH-m were done by one physician who were blinded to each other's.

Results: Patients with positive pH-m had Positive US and BM 90% (p = 0.004) and 50% (0.02) respectively and in those with negative pH-m the negative rate of us was 60% (p = 0.004) and negative rate of BM was 65% (P = 0.02). The rates of false positive and false negative were 60% and 10% in US and 65% and 50% in barium meal respectively. True positive and negative results were 90% and 40% for US and 50% and 35% for BM, respectively. The sensitivity and specificity rates were 90% and 40% for US and 50% and 35% for BM. The positive and negative predictive values were 69% and 72% for US and 53% and 31% for BM respectively.

Conclusion: Ultrasonography is much more sensitive and specific than barium meal in diagnosing GER with higher positive and negative predictive value. US is a safe, reliable and cost- effective procedure, so it could be used as the primary mode in diagnosing GER and use 24 hr pHm for follow up of resistant to treat patients.