[Acidic stimulation of esophageal peristalsis: its prognostic value in reflux].

Gastroesophageal Reflux (GER) in children manifests itself by several clinical pictures. Its diagnosis is difficult and so are surgical indications. The search for prognostic parameters able to predict the need for surgery are therefore warranted. We have demonstrated in previous studies in children with GER a decrease in propulsive peristalsis and an increase in non-propulsive activity. We have also reported that patients able to respond to medical treatment correct their motor trouble when acid is instilled into the esophagus, whereas those unable to respond to it do not. Aiming at clarifying the prognostic value of this acid challenge test we have thus measured Esophageal Motor Efficiency (EME) (prop. waves/h multiplied by mean pressure) in basal conditions and after acid challenge in 52 children divided into two groups according to their response to medical treatment during periods exceeding 6 months. EME in basal conditions did not allow differentiation between both groups, but EME after acid challenge did so. Optimum threshold value was 565, sensitivity 0.76, specificity 0.75, positive predictive value 87%, and negative predictive value 60%. This test seems to have some prognostic value in pediatric GER.