Evaluation of Gastroesophageal Reflux and Gastroesophageal Reflux Disease with Esophageal Endoscopy and Histology in Children

Objectives:The roles of esophageal endoscopy and mucosal biopsy in making diagnoses of gastroesophageal reflux( GER) and gastroesophageal reflux disease( GERD) were retrospectively examined in children.Methods:Thirty-four patients, whose ages ranged from 1 month to 18 years (median, 4 years), underwent diagnostic evaluation of GER/GERD. Group I patients( n=5) had symptoms suggesting GER, but had no underlying abnormalities. Group II patients( n=23) had chronic symptoms suggesting GERD and underlying abnormalities, neurologic impairment( n=22) and post-repair of esophageal atresia( n=1). Group III patients( n=6) were neurologically impaired but had no symptoms and underwent evaluation as a preoperative examination of gastrostomy placement. Reflux esophagitis was endoscopically graded according to the modified Los Angeles classification and grouped into grades?M, A, and?B. The results of GER studies and the histologic findings of reflux esophagitis were compared between these groups.Results:The parameters of 24-h pH monitoring were significantly higher in patients with grade?B than grade?M, and endoscopic grades improved after antireflux surgery along with the improvements in reflux index. There were no significant correlations between the endoscopic grade and the percentages of patients in whom histologic findings of reflux esophagitis were present.Conclusion:Esophageal endoscopy is useful for examining the severity of reflux esophagitis and monitoring the effect of treatment in children with GER/GERD. The modified Los Angeles classification can also be used for that purpose. Although treatment is seldom influenced by the results, histologic evaluation of the esophageal mucosa should be performed to exclude other disorders