Gastroesophageal reflux in children: results of a standardized fluoroscopic approach.

This retrospective study of 470 children undergoing barium upper gastrointestinal examinations was performed with three goals in mind: (1) to document the incidence of gastroesophageal reflux discovered during standardized upper gastrointestinal examination; (2) to compare the amount of gastroesophageal reflux detected in patients with symptoms suggestive of reflux as opposed to those who had no such symptoms; and (3) to ascertain the effect on reflux of the presence of a lower esophageal "beak." About 65% of the children studied had gastroesophageal reflux. Reflux was seen more commonly when symptoms of reflux were present (75.9%) than when not (36.8%). The amount of reflux seen over 5 min was greater if symptoms were present (mean incidence 2.72 bouts) than when not (mean incidence 0.76 bouts). Most importantly, there was a significant decrease in the amount of reflux seen with increase in patient age; age-related criteria for "acceptable" gastroesophageal reflux are presented. The presence of an esophageal "beak" is associated with an increased amount of reflux (94.4%) as opposed to no such "beak" (67.8%). The data suggest that gastroesophageal reflux is present in a large percentage of pediatric patients, whether there are symptoms to suggest reflux or not. Since reflux diminishes with increasing age, age-related criteria for an "acceptable" amount of reflux should be used rather than a universal judgment based on three episodes. Reflux to the cervical esophagus occurs frequently, both with and without symptoms of reflux, and may not be a reliable solitary indication for therapy. An esophageal "beak" is associated with an increase in reflux and may have important prognostic implications.