Yoo In Hyuk, Joo Jung Yeon, Yang Hye Ran
Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
J Neurogastroenterol Motil. 2021 Apr 30;27(2):191-197. doi: 10.5056/jnm20033.
BACKGROUND/AIMS: This study aim to evaluate the relationship between the Hill grade confirmed by esophagogastroduodenoscopy (EGD) and the degree of gastroesophageal reflux (GER) by 24-hour multichannel intraluminal impedance-pH monitoring (MII-pH) in children suspected of having gastroesophageal reflux disease (GERD).
A retrospective review of 105 children and adolescents who underwent EGD and MII-pH for the evaluation of GERD from March 2013 to July 2019 was performed. Clinical features and results of EGD and 24-hour MII-pH were collected and statistically analyzed.
Hill grades 1, 2, 3, and 4 were identified using EGD in 56 (53.3%), 22 (22.0%), 16 (15.2%), and 11 (10.5%) patients, respectively. As the Hill grade increased, the proportion of neurological diseases ( < 0.001) and endoscopic erosive esophagitis ( < 0.001) increased significantly. The acid exposure index, bolus exposure index, number of reflux episodes, and number of GER reaching proximal extent on MII-pH increased significantly as the endoscopic Hill grade increased (all < 0.001). Linear regression analysis revealed an increase in the Hill grade by 1 increased the acid exposure index by 2.0%, bolus exposure index by 0.7%, number of reflux episodes by 18.9 episodes, and the number of GER reaching the proximal esophagus increased by 10.5 episodes on average (all < 0.001).
Hill grade on EGD was associated with GER in children. Estimating the degree of GER by applying Hill grade in the retroflexion view may be useful in practice when evaluating children suspected with GERD.
背景/目的：本研究旨在评估在疑似患有胃食管反流病（GERD）的儿童中，经食管胃十二指肠镜检查（EGD）确定的希尔分级与24小时多通道腔内阻抗-pH监测（MII-pH）所测胃食管反流（GER）程度之间的关系。
对2013年3月至2019年7月期间接受EGD和MII-pH检查以评估GERD的105名儿童和青少年进行回顾性研究。收集EGD和24小时MII-pH的临床特征及结果并进行统计学分析。
EGD检查发现希尔分级为1级、2级、3级和4级的患者分别有56例（53.3%）、22例（22.0%）、16例（15.2%）和11例（10.5%）。随着希尔分级增加，神经疾病比例（<0.001）和内镜下糜烂性食管炎比例（<0.001）显著增加。MII-pH检查的酸暴露指数、团块暴露指数、反流发作次数以及GER到达近端的次数均随着内镜下希尔分级增加而显著增加（均<0.001）。线性回归分析显示，希尔分级每增加1级，酸暴露指数增加2.0%，团块暴露指数增加0.7%，反流发作次数增加18.9次，GER到达食管近端的次数平均增加10.5次（均<0.001）。
EGD检查的希尔分级与儿童GER相关。在评估疑似GERD的儿童时，应用倒转视图下的希尔分级来估计GER程度在实际应用中可能有用。
