From the Section of Pediatric Gastroenterology, Yale School of Medicine, New Haven, CT.
the Division of Gastroenterology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
J Pediatr Gastroenterol Nutr. 2022 Oct 1;75(4):450-454. doi: 10.1097/MPG.0000000000003561. Epub 2022 Jul 13.
Children on the autism spectrum disorder (ASD) may express pain or discomfort through stereotypic or self-injurious behaviors. Gastroesophageal reflux disease (GERD) may be challenging to diagnose in a child who is non-verbal or has impaired communication skills, diagnostic testing for GERD may be the only way to establish the diagnosis. We report our experience using the BRAVO wireless pH monitoring device for the evaluation of GERD in this patient population.
Tolerance and feasibility as well as pH parameters and symptom correlation of the BRAVO pH were evaluated retrospectively in ASD children and compared it to a large cohort of non-ASD children. Only patients with studies lasting >24 hours were included.
A total of 172 patients were included, 27 of those were diagnosed with autism (median age 11 years, 17 male). We found no difference in age and weight between both groups but there was a male predominance in the autism group ( P = 0.007). We found no difference in the ability to complete at least 24 hours of study duration between both groups (24/27 or 89% in ASD vs 133/145 or 92% non-ASD patients, P = 0.632). We also found no difference in the median reflux index on the worst day ( P = 0.27) or the average of both days ( P = 0.75), BRAVO pH parameters and the proportion of abnormal studies between ASD and non-ASD children. When evaluating the overall symptom correlation with GER episodes, we did not find a difference between both groups, but we did find a higher symptom correlation for GER symptom during supine position in ASD children. Study was performed for behavioral indication in 11 ASD children, all had normal esophageal mucosa but 4 of those had an abnormal BRAVO pH study. No significant side effects were reported during the study, only 2 patients (1 non-ASD and 1 ASD) complained of self-limited chest pain.
BRAVO wireless pH is well tolerated and feasible in evaluating GER and behavioral symptoms in ASD children and provides a reasonable alternative to standard trans-nasal pH monitoring.
自闭症谱系障碍（ASD）儿童可能会通过刻板或自伤行为来表达疼痛或不适。对于无法言语或沟通能力受损的儿童，胃食管反流病（GERD）可能难以诊断，诊断性GERD 测试可能是建立诊断的唯一方法。我们报告了使用 Bravo 无线 pH 监测仪评估该患者群体中 GERD 的经验。
回顾性评估 Bravo pH 的耐受性和可行性以及 pH 参数和症状相关性，并将其与大量非 ASD 儿童进行比较。仅纳入研究持续时间>24 小时的患者。
共纳入 172 例患者，其中 27 例诊断为自闭症（中位年龄 11 岁，男性 17 例）。我们发现两组在年龄和体重方面没有差异，但自闭症组男性居多（P=0.007）。我们发现两组完成至少 24 小时研究持续时间的能力没有差异（24/27 或 89%在 ASD 中，133/145 或 92%在非 ASD 患者中，P=0.632）。我们还发现最差日和平均日反流指数中位数（P=0.27）或平均日反流指数中位数（P=0.75）、Bravo pH 参数和异常研究比例在 ASD 和非 ASD 儿童之间均无差异。当评估 GER 发作与总体症状相关性时，我们发现两组之间没有差异，但我们确实发现 ASD 儿童仰卧位时 GER 症状的相关性更高。11 例 ASD 儿童因行为指征进行研究，所有儿童食管黏膜均正常，但其中 4 例 Bravo pH 研究异常。研究过程中未报告明显的副作用，只有 2 例患者（1 例非 ASD，1 例 ASD）诉自限性胸痛。
Bravo 无线 pH 可耐受且可行，可用于评估 ASD 儿童的 GER 和行为症状，并为标准经鼻 pH 监测提供合理替代方案。
