P0979 POSSIBLE ROLE OF ULTRASONOGRAPHY IN THE DIAGNOSIS OF GASTROESOPHAGEAL REFLUX DISEASE:

Introduction: Ultrasonography is a non-invasive technique with controversial diagnostic potential in gastroesophageal reflux disease (GERD). Methods: We aimed at defining the correlation of published ultrasonographic parameters of pathologic GER (i.e. reflux episodes >5 at <2 months, >4 at 2 months–2 years and >3 at >2 years of age) with a diagnosis of GERD based on clinical criteria supported by the results of well established clinical investigations. We therefore evaluated in a prospective fashion 26 patients (16 boys and 10 girls, median age 20 months, age range 20 days–16 years) with suspected GERD: 12 had typical symptoms (regurgitation, fussing and arching with meals, heartburn, dysphagia) and 14 had atypical manifestations (12 persistent or recurrent respiratory manifestations, 2 bradycardia/hypotonia/cyanosis episodes). All patients underwent one or more of the clinical investigations which were considered necessary to formulate a definite diagnosis of GERD, i.e. 24 hour dual-channel intra-esophageal pH monitoring, endoscopy with biopsy and scintigraphy. Ultrasonography was carried out with a convex 3.5 MHz probe oriented longitudinally to the esophagogastric junction while the patient was lying in a supine position, for a 10–15 minute period following a liquid meal (milk or tea, depending on the patient’s age and preference). Results: Twenty-one out of 26 patients had a final diagnosis of GERD: 10/14 (72%) had endoscopic or histologic evidence of esophagitis, 9/14 (64%) had an abnormal intraesophageal pH study and in 7/12 (60%) scintigraphy demonstrated pulmonary aspiration associated with delayed gastric emptying in 6/12 (50%). Ultrasonography showed the presence of a pathologic number of reflux episodes in 18/26 patients: 17/21 (80%) with a diagnosis of GERD and 1/5 (20%) where GERD was excluded. Compared to the final diagnosis of GERD, the ultrasonographic evaluation of the above parameters showed a sensitivity of 90% in patients with typical symptoms, 73% in patients with atypical manifestations, 80% in patients <2 years and 82% in patients >2 years of age, respectively. More infants and children with no gastrointestinal disease are currently being studied in order to better evaluate the specificity of ultrasonographic parameters. Conclusion: With an overall sensitivity of 80% and a sensitivity of 90% in patients with typical GERD symptoms, short-time ultrasonographic evaluation of postprandial reflux episodes has an acceptable correlation with the clinical and instrumental diagnosis of GERD. Given its wide availability, non-invasiveness, easy use and relatively low cost, this technique could be used as a screening test in infants and children with suspected GERD.