WHY DON'T WE USE SONOGRAPHY BY CHILDREN WITH GASTROESOPHAGEAL REFLUX? THE ULTRASONOGRAPHIC FEATURES OF GASTROESOPHAGEAL REFLUX BY CHILDREN

Purpose: Because sonography of the gastroesophageal junction is not common diagnostic method of gastroesophageal reflux (GER) and many guidelines for the management of pediatric GER do not even include this kind of examination. The aim of this study was to determine usefulness of sonography in GER diagnostic in patients with clinical symptoms suggesting GER. Methods and Materials: In this prospective study, we examined sonographic 50 children (28 boys, 22 girls) aged 4 months to 14 years (mean 33 months). All children had recurrent respiratory infections; we chose them because recurrent respiratory infections are one of GER symptoms. For visualization of the stomach cardia and the subdiaphragmatic part of the esophagus the transducer was placed in the midline below xiphoid. Through the window of the left lobe of the liver we described the length of the abdominal part of esophagus, the His ankle, and the presence of the passage of gastric fluid into the abdominal esophagus (GER). In the group of children with GER the follow-up examination after two months treatment (cisapride) has taken place and the results were compared. All procedures were taken with institutional ethics committee approval by students under clinicians' control. Results: The gastroesophageal junction was identified by ultrasonography in all 50 children. On the first sonography, 37/50 patients (74%) had GER, in 62% in this group the His ankle was obtuse and the median subdiaphragmatic esophagus length was 13,4mm, mean 13,6mm (SE 0,6mm). In non-GER children group the His ankle in 30% was obtuse and the median length of subdiaphragmatic part of the esophagus was 18,3mm, mean 17mm (SE 1,4mm).There was significant difference between the length of subdiaphragmatic part of the esophagus in both groups (p