Diagnostic Modalities for Gastro-Esophageal Reflux in Infantile Wheezers

Abstract

Both GER scan and 24-h pH study are complimentary to each other, however, if both the tests are available then GI scintiscan is better as a single test for GER in these early wheezers.

Official American Thoracic Society Clinical Practice Guidelines: Diagnostic Evaluation of Infants with Recurrent or Persistent Wheezing

“…Another study of infants with wheezing used clinical history and a response to anti-GER therapy as the reference standard instead of 24-hour pH monitoring. It found that gastroesophageal scintigraphy detected GER with a sensitivity and specificity of 58 and 85%, respectively, when a history compatible with GER was used as the reference standard, and with a sensitivity and specificity of 79 and 50%, respectively, when a response to anti-GER therapy was used as the reference standard (90). Finally, two studies did not compare gastroesophageal scintigraphy with a reference standard, but rather, reported that the technique identified GER in 22% of infants and children (age, 3 mo-4 yr) who presented with recurrent wheezing or vomiting (91) and in 26% of infants and children (age, 6 mo-6 yr) who presented with difficult-to-treat asthma (92); these yields were lower than the 67-100% described previously for 24-hour esophageal pH monitoring.…”

Diagnosis and management of early asthma in preschool-aged children

“…Gastroesophageal reflux disease (GERD) is common in infancy and might be associated with chronic or recurrent respiratory tract symptoms, including wheezing, 26,27 although there remains uncertainty as to whether symptomatic gastroesophageal reflux is actually causative of wheezing in childhood or represents the unrelated coexistence of 2 relatively common problems (wheezing and GERD). 27 It has been estimated that as many as 45% to 65% of children with asthma have GERD.…”

“…27 It has been estimated that as many as 45% to 65% of children with asthma have GERD. 28 However, a recent trial in school-aged children with poorly controlled asthma using ICSs without symptoms of GERD demonstrated that treatment with proton-pump inhibitors compared with placebo improved neither symptoms nor lung function but was associated with increased respiratory tract infections, 29 with similar findings among the group of children (43%) with evidence of GERD on pH probe testing.…”

Wheezing in preschool children

“…Several studies [42][43][44] have demonstrated the effectiveness of ICS in reducing the severity of symptoms, bronchial hyperresponsiveness and the frequency of exacerbations, as well as in improving lung function [45][46][47], in multi-trigger phenotype.…”