Evaluating the yield of gastrointestinal testing in pediatric patients in aerodigestive clinic

Abstract

Objective To improve understanding of the interrelatedness of airway and esophageal diagnoses by evaluating the yield of procedural and radiographic testing of the gastrointestinal tract in children with airway conditions by their referring diagnoses in a pediatric aerodigestive clinic. Methods A retrospective chart review of all 325 patients seen in the aerodigestive program from 2010 to 2013 was performed in a single academic medical center. Demographics and results from esophagogastroduodenoscopies with biopsies (EGD), upper gastrointestinal fluoroscopy studies (UGI), and pH multichannel intraluminal impedance probe (pH‐MII) performed within 30 days of the clinic visit were evaluated according to presenting diagnoses. Results Mean patient age was 3.15 years (range 0.15‐24 years) and 41.2% were born premature. 189/325 (58.1%) were on acid suppression. A total of 295 EGD, 193 pH‐MII, and 54 UGI were performed. The most common diagnosis with an abnormal pH‐MII was asthma. The most common diagnoses with an abnormal EGD were feeding difficulty and tracheal esophageal fistula/ esophageal atresia (TEF/EA). EGDs were normal in 188/295 (63.7%), while 39/295 (13.2%) demonstrated esophagitis, and 22/295 (7.5%) had >15 esophageal eosinophils per high power field. The majority of pH‐MII (144/193 [74.6%]) and UGI (47/54 [87%]) were normal. Conclusions Children with feeding difficulty, TEF/EA, and asthma were the mostly likely to have a histologic abnormality on EGD or an abnormal pH‐MII. The majority of children were previously prescribed acid suppression medication and had a referring diagnosis of gastroesophageal reflux disease but were subsequently found to have normal evaluation. Prospective studies are needed to optimize care of this population.

Integrative diagnostics of the gastro-intestinal tract – gastroesophageal reflux and constipation in practice

“…Aksglaede calculated a specificity of 100% and a sensitivity of 52% for UGI (compared to 24-h pH monitoring) [ 12 ]. For UGIs, DeBoer et al published a sensitivity of 47.3%, specificity 74.2%, and positive predictive value of 50%, but there was no information given on either technique or provocative maneuver use (in particular, whether a water-siphon test was performed) [ 13 ]. Thompson et al demonstrated in their study of 117 patients that UGIs detect unprovoked, spontaneous GER in only 26% of ph-monitoring–positive patients.…”

Pediatric Aerodigestive Medicine: Advancing Collaborative Care for Children With Oropharyngeal Dysphagia

“…Thirty‐six percent of aerodigestive EGDs are histologically abnormal, including esophagitis, gastritis, EoE, and duodenitis (27). Children with EA could develop EoE at a younger age (28).…”

Making the case for multidisciplinary pediatric aerodigestive programs

“…Implementation of culture directed antibiotics prior to or during open airway reconstruction surgery can therefore improve outcomes. Studies have demonstrated that specific subsets of aerodigestive patients are more likely to have abnormal mucosal histology on upper GI endoscopy and/or abnormal impedance pH testing[ 22 , 23 ]. This includes those with previously diagnosed asthma, feeding difficulty, and esophageal atresia with or without tracheoesophageal fistula, with 40%-50% yield on upper GI testing[ 22 ].…”

“…Studies have demonstrated that specific subsets of aerodigestive patients are more likely to have abnormal mucosal histology on upper GI endoscopy and/or abnormal impedance pH testing[ 22 , 23 ]. This includes those with previously diagnosed asthma, feeding difficulty, and esophageal atresia with or without tracheoesophageal fistula, with 40%-50% yield on upper GI testing[ 22 ]. Findings noted included reflux esophagitis and EoE.…”