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Challenges in the diagnosis of gastroesophageal reflux disease in infants and children

机译：婴幼儿胃食管反流疾病的诊断挑战

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Introduction: The diagnosis of gastroesophageal reflux disease (GERD) is challenging. The wide variation in symptoms is a major reason for the controversies. Since the expression of GERD varies from nonerosive reflux disease over Barrett's esophagus to chronic respiratory disease, it is clear that not one investigation technique will provide an answer in all situations. Areas covered: Relevant literature published in PubMed and CINAHL and recent guidelines were collected and reviewed. Diagnostic tests were evaluated by the following criteria: ability to confirm a diagnosis, to exclude other diagnoses with similar presentation, to detect complications, to predict disease severity. Expert opinion: Multiple intraluminal impedance (MII) is extensively evaluated in recent years, but other new techniques and measurements were also developed, mainly to diagnose extra-esophageal symptoms. Although evidence for a "relation" between GER and extra-esophageal symptoms is demonstrated, the "causality" between both is not proven. MII measures in a reliable reproducible way non-acid or weakly acid reflux. However, as long as medical therapeutic options are limited to anti-acid medications, MII lacks therapeutic implications, and therefore clinical impact. Since investigations for GER are invasive or cause irradiation, normal ranges cannot be established. As a consequence, the "old" techniques remain the standard diagnostic tools: barium meal for anatomy, endoscopy for esophagitis, and pH monitoring to demonstrate a time relation between (acid) GER and symptoms. MII provides more information than pH monitoring, but is more expensive and has limited therapeutic impact as long as drugs are mainly "anti-acid."
机译：简介：胃食管反流病（GERD）的诊断具有挑战性。症状的广泛差异是引起争议的主要原因。由于GERD的表达从从Barrett食道的非侵蚀性反流病到慢性呼吸道疾病不等，因此很明显，没有一种研究方法能够在所有情况下提供答案。涵盖领域：收集并审查了发表在PubMed和CINAHL上的相关文献以及最新指南。通过以下标准对诊断测试进行评估：确认诊断的能力，排除具有相似表现的其他诊断，检测并发症，预测疾病严重程度的能力。专家意见：近年来，对腔内多阻抗（MII）进行了广泛评估，但是还开发了其他新技术和测量方法，主要用于诊断食管外症状。尽管有证据表明GER与食管外症状之间存在“联系”，但两者之间的“因果关系”尚未得到证实。 MII以可靠的可重复方式测量非酸或弱酸回流。但是，只要医学治疗选择仅限于抗酸药物，MII缺乏治疗意义，因此缺乏临床影响。由于对GER的研究是侵入性的或引起辐射的，因此无法建立正常范围。因此，“旧”技术仍然是标准的诊断工具：用于解剖的钡餐，用于食管炎的内窥镜检查以及用于监测（酸）GER与症状之间时间关系的pH监测。 MII比pH监测提供更多信息，但只要药物主要是“抗酸”药物，它就更昂贵且治疗效果有限。

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