Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
J Pediatr. 2013 May;162(5):983-7.e1-4. doi: 10.1016/j.jpeds.2012.10.041. Epub 2012 Dec 7.
To systematically review the literature evaluating the diagnostic accuracy of commonly used diagnostic tests over conventional history taking and physical examination in children ≤ 18 months and >18 months suspected of gastroesophageal reflux disease (GERD).
We searched Medline, Embase, and the Cochrane database for studies assessing the diagnostic accuracy of pH-metry, pH-impedance, esophagogastroscopy, barium contrast study, scintigraphy, and empirical treatment as diagnostic tools. Quality was assessed according to Quality Assessment of Studies of Diagnostic Accuracy Included in Systematic Reviews criteria.
Of the 2178 studies found, 6 studies were included, containing 408 participants (age 1 month-13.6 years) and 145 controls (age 1 month-16.9 years). Studies included children with GERD symptoms; 1 included an atypical presentation. In all the studies, the diagnostic accuracy of pH-metry was investigated, and in 2 studies esophagogastroscopy was investigated as well. Sensitivity and specificity were calculated in 3 studies. The range of reported sensitivity and specificity was broad and unreliable because of poor methodological quality according to Quality Assessment of Studies of Diagnostic Accuracy Included in Systematic Reviews criteria and inadequate study design.
Diagnostic accuracy of tests in children suspected of GERD remains unclear and implications for practice are hard to give. There is an urgent need of well-designed randomized controlled trials where the effect of treatment according to specific signs and symptoms will be compared with the effect of treatment based on the results of additional diagnostic tests, for patient relevant outcomes.
系统评价评估常用诊断测试在 18 个月及 18 个月以下疑似胃食管反流病（GERD）的儿童中相对于传统问诊和体格检查的诊断准确性的文献。
我们检索了 Medline、Embase 和 Cochrane 数据库，以评估 pH 监测、pH 阻抗、食管胃十二指肠镜检查、钡剂造影、闪烁扫描和经验性治疗作为诊断工具的诊断准确性。根据系统评价中纳入的诊断准确性研究质量评估标准对质量进行评估。
在 2178 项研究中，有 6 项研究入选，共纳入 408 名参与者（年龄 1 个月至 13.6 岁）和 145 名对照者（年龄 1 个月至 16.9 岁）。这些研究纳入了有 GERD 症状的儿童；其中 1 项研究纳入了非典型表现。在所有研究中，均研究了 pH 监测的诊断准确性，并且在 2 项研究中也研究了食管胃十二指肠镜检查。有 3 项研究计算了敏感性和特异性。根据系统评价中纳入的诊断准确性研究质量评估标准和不充分的研究设计，报道的敏感性和特异性范围很广且不可靠。
疑似 GERD 的儿童的测试诊断准确性仍不清楚，对实践的影响难以给出。迫切需要设计良好的随机对照试验，将根据特定症状和体征进行治疗的效果与根据额外诊断测试结果进行治疗的效果进行比较，以获得患者相关的结果。
