Ultrasound diagnosis of gastro-oesophageal reflux.

Abstract

SUMMARY A method of diagnosing gastrooesophageal reflux using ultrasound is described. This method was compared with barium swallow examination in 20 patients and found to be as accurate in infants and young children.Gastro-oesophageal reflux is an important cause of failure to thrive in infants and children. It may also lead to blood loss and repeated chest infections and is implicated as one of the factors in 'cot death'.' Barium swallow examination is the established method of diagnosing reflux in infants and children. In our department 64 barium examinations were carried out in 1982 for suspected gastro-oesophageal reflux. We describe a method of diagnosing this important condition using real time ultrasound equipment. Materials and methodTwenty infants and children from age 4 days to 16 years were studied by both barium and ultrasound techniques. The examinations were performed by two operators. The barium swallow was done first and was followed almost immediately by ultrasound, without the second operator knowing the result of the barium examination.For the barium examination, a standard technique was used combined with fluoroscopy and spot films. Ultrasound examinations were carried out with the patient in the supine position. A commercially available real time sector scanner (ATL 500) was used with 3.5 MHz in-line transducer with a 900 sector. The transducer was placed in the epigastrium below the xiphisternum to obtain a midline sagittal section going through the skin and subcutaneous tissues, left lobe of the liver, aorta, left hemidiaphragm, and the spine. It is important that the section contains several centimetres length of the long axis of the aorta and certainly 1 to 2 cm above and 2 cm below the diaphragm. The transducer is then moved to the right of the midline (approximately 2 cm) and the beam is angled slightly medially to ensure that the aorta remains in the section. In our experience, the cardia is outlined easily with this slight angulation of the beam. To ensure that the oesophagus empties completely the baby is held in the erect position or the child is made to sit up at least twice and is then scanned again in the supine position. The examination is observed on the screen and recorded intermittently on a video cassette recorder. Hard copy on photographic paper is obtained by a freeze frame facility but this leads to considerable degradation of the recorded detail of the dynamic nature of the reflux.Results

Transcutaneous cervical esophagus ultrasound in adults: Relation with ambulatory 24-h pH-monitoring and esophageal manometry

“…24-h pH monitoring and multichannel intraluminal impedance (MⅡ) are the gold standard techniques to evaluate GER [19,34,35] . US has been used in GERD since 1984 [36] . The GEJ was first described by Westra [6] and Gomes [1] during US by transabdominal route.…”

Ultrasound demonstration of gastroesophageal reflux.

“…'- 13 Although ultrasound has been employed with success for the diagnosis of GER, 14 we are unaware of its previous use to explore the relationship between GER and apnea. Two studies 7 • 13 employing polysomnographic and esophageal pH recording to demonstrate the relationship between GER and apnea yielded conflicting results.…”

Sensibilidade da seriografia do esôfago, estômago e duodeno para o diagnóstico de doença do refluxo gastroesofágico em recém-nascidos prematuros

“…Gastroesophageal reflux disease has also been associated with apparently life-threatening complications such as aspiration pneumonias and apnea, significantly extending the hospital stay of such neonates (2,(4)(5)(6)(7)(8)(9)(10)(11)(12)(13) . Although the longterm esophageal pH monitoring is still considered as the gold standard for the diagnosis of GERD, it presents the disadvantages of an invasive and expensive procedure, besides demanding specialized personnel and equipment, and for these very ciated with digestive and extra-digestive symptoms such as frequent regurgitation and vomiting episodes in association with low weight gain, anemia, esophagitis or respiratory complications (1,2) .…”