CHILDREN, GASTROESOPHAGEAL REFLUX AND ULTRASOUND
While a few studies have excluded ultrasound as a reliable diagnostic tool in screening for gastroesophageal reflux disease (GERD) in infant and children, others have referred to ultrasound as the screening test of choice in symptomatic patients and for patients follow-up. In this study, we evaluated the sensitivity and specificity of ultrasound in diagnosing GERD in children. This caseـcontrol study involved 56 patients and 50 controls. Inclusion criteria were age below 14 years, exhibiting GERD symptoms, having been chosen as a candidate for esophageal endoscopy and biopsy by a pediatric gastroenterology subspecialist, pathology or 24-hour pH-metry result suggestive of GERD, absence of obstructive gastrointestinal tract diseases, metabolic or other systemic diseases and having received no medications prior to the study. Ultrasound examination was performed for both patients and controls; endoscopy and 24-hour pH-metry were done for all patients and those in control group who had abnormal findings in ultrasound exam. Pediatric gastroenterologist's final judgment based on clinical and paraclinical findings constituted the gold standard. Sensitivity, specificity, positive predictive value and negative predictive value of ultrasound in diagnosing GERD were 76%, 100%, 100% and 79%, respectively. The mean length of subdiaphragmatic part of esophagus was 6.36 mm shorter in children with reflux than that in subjects without reflux and the difference was significant. Ultrasound can successfully be used as the first diagnostic approach in children with GERD.