Impacts of Endoscopic Gastroesophageal Flap Valve Grading on Pediatric Gastroesophageal Reflux DiseaseReportar como inadecuado

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Gastroesophageal flap valve GEFV endoscopic grading is reported to be associated with gastroesophageal reflux disease GERD in adults; however its role in pediatric groups remains unknown. This study aimed to investigate the significance of GEFV grading and the associations to multichannel intraluminal impedance and pH monitoring MII-pH in children with GERD.


A total of 48 children with GERD symptoms who received esophagogastroduodenoscopy and MII-pH monitoring were enrolled. The degree of GEFV was graded from I to IV according to the Hill classification, and classified into two groups: normal GEFV Hill grades I and II, and abnormal GEFV Hill grades III and VI. Endoscopic findings and MII-pH monitoring were analyzed among the groups.


Thirty-six patients had normal GEFV while 12 had abnormal GEFV. The presence of erosive esophagitis was significantly more common in the patients with abnormal GEFV p = 0.037, OR 9.84, 95% CI 1.15–84.42. Pathological acidic gastroesophageal reflux GER determined by MII-pH was more prevalent in the patients with loosened GEFV geometry p = 0.01, OR 7.0, 95% CI 1.67–27.38. There were significant positive correlations between GEFV Hill grading I to IV and the severity of erosive esophagitis r = 0.49, p<0.001, percentage of supine acid reflux r = 0.37, p = 0.009, percentage of total acid reflux r = 0.3284, p = 0.023, and DeMeester score r = 0.36, p = 0.01 detected by pH monitoring. In the impedance study, GEFV Hill grading also positively correlated to median number of acid reflux events r = 0.3015, p = 0.037.


GEFV dysfunction highly associated with acid GER and severe erosive esophagitis. An abnormal GEFV is a sign of acid GER in children.

Autor: Kai-Chi Chang, Jia-Feng Wu, Wei-Chung Hsu, Bor-Ru Lin, Huey-Ling Chen, Yen-Hsuan Ni



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