Are endoscopic changes predictive of histologic esophagitis in children?

Biller, Jeffrey A.; Winter, Harland S.; Grand, Richard J.; Allred, Elizabeth N.

doi:10.1016/s0022-3476(83)80347-3

Cited by 114 publications

(48 citation statements)

References 9 publications

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“…Uma EDA normal, ou ausência de lesões macroscópicas, não exclui a presença de esofagite histoló-gica 16 . Nesses casos, a esofagite será restrita a alterações mínimas, e não será grave.…”

Section: Discussionunclassified

Diagnosis of reflux esophagitis in infants: histology of the distal esophagus must complement upper gastrointestinal endoscopy

Vieira¹,

Pisani²,

Mulinari³

2004

J Pediatr (Rio J)

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Objective: The aim of this study was to validate the endoscopic findings against histologic features of the distal esophageal mucosa for the diagnosis of reflux esophagitis in infants.Methods: The data records of 167 patients (88 M; 79F) aged 38-364 days, referred for investigation of reflux esophagitis, between January 1995 and December 2000 were retrospectively reviewed. The association between nominal (presence or absence of esophagitis) and ordinal (grades of esophagitis) variables was analyzed through a correlation between the results of endoscopic findings and histology.Results: Endoscopy when compared with histologic analysis had a sensitivity of 45%; specificity of 71%; positive and negative predictive value of 89% and 21% respectively; and accuracy of 50%. Additionally, this study demonstrated that there was a poor correlation between endoscopic and histologic findings when endoscopy was normal or when endoscopic grade I esophagitis was observed (p = 0.10). Normal esophageal appearance failed to identify 79.2% of patients with histologic esophagitis. Conversely, amongst patients with endoscopic grade I esophagitis, 12.1% had normal histology. Conclusions:We concluded that whilst endoscopy had a specificity of 71%, it did not attain an acceptable range of sensitivity (45%) to justify performing an endoscopy without biopsy, as many true cases of esophagitis would not be detected; and that the presence of grade I (non-erosive) esophagitis at endoscopy did not increase the value of the test in predicting histologic abnormality. ResumoObjetivo: O objetivo deste estudo foi o de validar os resultados do exame de endoscopia digestiva alta contra a histologia do esôfago distal para o diagnóstico da esofagite de refluxo em lactentes.Métodos: Foram revisados os prontuários de 167 pacientes (88 do sexo masculino e 79 do sexo feminino) com idade de 38 a 364 dias, encaminhados para investigação de esofagite de refluxo no período de janeiro de 1995 a dezembro de 2000. Analisou-se a associação entre as variáveis nominais (presença ou ausência de esofagite) e ordinais (graus de esofagite) através da comparação entre os resultados da endoscopia digestiva alta e histologia.Resultados: A endoscopia digestiva alta, quando comparada à histologia, apresentou sensibilidade de 45%, especificidade de 71%, valores preditivos positivo de 89% e negativo de 21%, e acurácia de 50%. Verificou-se baixa concordância entre os achados endoscópicos e histológicos na endoscopia digestiva alta normal ou na esofagite grau I (eritema leve ao nível da transição epitelial, apagamento, friabilidade e perda do brilho da mucosa) (p = 0,10). A endoscopia digestiva alta normal não identificou 79,2% dos pacientes com esofagite histológica. Entre os pacientes com esofagite grau I à endoscopia digestiva alta, 12,1% não apresentaram alterações histológicas.Conclusões: Concluiu-se que, enquanto a endoscopia digestiva alta apresentou especificidade de 71%, não atingiu sensibilidade aceitável (45%) para justificar sua realização sem biópsia; e que ...

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Section: Discussionunclassified

Diagnosis of reflux esophagitis in infants: histology of the distal esophagus must complement upper gastrointestinal endoscopy

Vieira¹,

Pisani²,

Mulinari³

2004

J Pediatr (Rio J)

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“…Normal endoscopic findings, namely lack of an erosion or mucosal break, do not rule out histopathologic esophagitis. In fact, microscopic esophagitis has been found in one-third of children without any endoscopic lesion in another study done by Biller et al (45). Furthermore, it has been reported that microscopic changes are more frequent in esophageal biopsy samples obtained from patients with nonerosive reflux disease (NERD) than in the controls (20,23).…”

Section: Discussionmentioning

confidence: 96%

What is the diagnostic utility of endoscopic scoring systems in children?

Tutar

Kutluk²,

Bayrak³

et al. 2009

Turk J Gastroenterol

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“…[3][4][5][14][15][16][17] Çocuk hastalarda yapılan çalışma sonuçları, erişkin hastalardakinin aksine semptomlar ile özofajit varlığı arasındaki ilişkinin iyi olmadığını göstermiş-tir. 4,5,18,19 İtalya'da 2007 yılında yayınlanan yaşları 1-18 arasında değişen 136 çocuğu kapsayan, Lombardi ve ark.nın çok merkezli bir çalışmasında semptomların histolojik özofajit ile ilişkisinin iyi olmadığı görülmüştür. 20 Bizim çalışmamızda da GÖRH semptomları tek tek ele alındıklarında endoskopik özofajit ve histolojik reflü özofajit (ERH veya EORH) tanıları ile istatistiksel yönden anlamlı bir ilişki gösterilememiştir.…”

Section: Discussionunclassified

“…tarafından, 1978-1982 yıllarında, yaş ortalaması çalışma grubumuz ile benzerlik gös-teren 279 çocuk hasta retrospektif olarak değerlen-dirilmiştir. 18 Çalışmada en sık rastlanan endoskopi endikasyonları tekrarlayan karın ağrısı ve kusma yakınması olarak bildirilmiştir. Hyams ve ark.…”

Section: Discussionunclassified