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KMID : 1812020230290020156
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Journal of Neurogastroenterology and Motility
2023 Volume.29 No. 2 p.156 ~ p.165
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Prevalence of Non-erosive Esophageal Phenotypes in Children: A European Multicenter Study
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Elisa Blas
Ettore Stefanelli
Renato Tambucci
Silvia Salvatore
Paola De Angelis
Paolo Quitadamo
Claudia Pacchiarotti
Giovanni Di Nardo
Fanj Crocco
Valentina Giorgio
Nicoletta Staropoli
Simona Sestito
Efstratios Saliakellis
Osvaldo Borrelli
Licia Pensabene
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Abstract
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Background/AimsSince available data on pediatric non-erosive esophageal phenotypes (NEEPs) are scant, we investigated their prevalence and the phenotype-dependent treatment response in these children.
MethodsOver a 5-year period, children with negative upper endoscopy, who underwent esophageal pH-impedance (off-therapy) for persisting symptoms not responsive to proton pump inhibitor (PPI)-treatment, were recruited. Based on the results of acid reflux index (RI) and symptom association probability (SAP), patients were categorized into: (1) abnormal RI (non-erosive reflux disease [NERD]), (2) normal RI and abnormal SAP (reflux hypersensitivity [RH]), (3) normal RI and normal SAP (functional heartburn [FH]), and (4) normal RI and not-reliable SAP (normal-RI-not otherwise-specified [normal-RI-NOS]). For each subgroup, treatment response was evaluated.
ResultsOut of 2333 children who underwent esophageal pH-impedance, 68 cases, including 18 NERD, 14 RH, 26 FH, and 10 normal-RI-NOS were identified as fulfilling the inclusion criteria and were analyzed. Considering symptoms before endoscopy, chest pain was more reported in NERD than in other cases (6/18 vs 5/50, P = 0.031). At long-term follow-up of 23 patients (8 NERD, 8 FH, 2 RH, and 5 normal-RI-NOS): 17 were on PPIs and 2 combined alginate, 1 (FH) was on benzodiazepine + anticholinergic, 1 (normal-RI-NOS) on citalopram, and 3 had no therapy. A complete symptom-resolution was observed in 5/8 NERD, in 2/8 FH, and in 2/5 normal-RI-NOS.
ConclusionsFH may be the most common pediatric NEEP. At long-term follow-up, there was a trend toward a more frequent complete symptom resolution with PPI-therapy in NERD patients while other groups did not benefit from extended acid-suppressive-treatment.
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KEYWORD
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Children, Functional heartburn, Gastroesophageal reflux disease, Non-erosive reflux disease, Reflux hypersensitivity
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