Esophageal pH value monitoring of gastroesophageal reflux in children and ultrasound observation of gastric cardia angle

  Objective  To explore the diagnostic value of 24 h esophageal dynamic pH value monitoring and ultrasound observation of gastric cardia (His) angle in children with gastroesophageal reflux (GER).

  Methods  A total of 188 children with suspected gastroesophageal reflux in children were selected as research objects. All children underwent ultrasonic examination to measure His Angle, and 24 h esophageal pH value was dynamically monitored to analyze the risk factors of GER, and the diagnostic value of His Angle and 24 h esophageal pH value for GER was evaluated by receiver operating characteristic (ROC) curve.

  Results  Of 188 children with suspected GER, there were 142 cases (GER group) with GER and 46 cases (non-GER group) without GER according to Boix-Ochoa standard assessment. His angle, pH value < 4 total reflux time ratio, pH value < 4 reflux time percentage in standing position, pH value < 4 reflux time percentage in lying position, average number of reflux cycles, times of reflux duration ≥ 5 min, and the longest reflux duration were significantly more or longer than those of the non-GER group, and the differences were statistically significant (P < 0.05). Logistic regression analysis showed that course of disease was protective factors for GER (OR=0.075, P < 0.05), while vomiting, His angle, pH value < 4 total reflux time ratio, the total reflux time ratio, the average number of reflux cycles, and the duration of reflux ≥ 5 min times and the longest reflux duration were high risk factors for GER (OR=3.609, 1.221, 8.600, 1.124, 46.136, 1.574, P < 0.05). ROC curve results showed that the area under the curve (AUC) of His angle, pH value < 4 total reflux time ratio, average number of reflux cycles, reflux duration ≥ 5 min times, and longest reflux duration in predicting GER were 0.912, 0.998, 0.963, 0.988, 0.986, respectively.

  Conclusion  Ultrasound measurement of esophageal His and 24 h esophageal dynamic pH monitoring are of high diagnostic value for GER, and can be used as an effective method for GER screening.