Üst Gastrointestinal Sistem Floroskopi Yapılan Pediatrik Hastalarda Gastroözofageal Reflü Tanısını Etkileyen Faktörler

Amaç: Bu çalışmanın amacı bebeklerde ve çocuklarda üst gastrointestinal floroskopi sonuçlarını değerlendirmek, sonuçları etkileyen faktörleri ve gastroözofageal reflü (GÖR) tanısını araştırmaktır. Yöntemler: Dr. Sami Ulus Kadın Doğum, Çocuk Sağlığı ve Hastalıkları Eğitim ve Araştırma Hastanesi Pediatrik Radyoloji Bölümü'nde 1 Ocak 2018 ile 31 Aralık 2018 tarihleri arasında üst gastrointestinal sistem floroskopisi uygulanan 1 aylık ile 18 yaş arasındaki hastalar çalışmaya dahil edildi. Hastaların dosyaları retrospektif olarak incelendi. Bulgular: Üst gastrointestinal sistem floroskopisi yapılan 76 hastanın% 46.1'i erkek, ortanca yaşı 10 aydı. Bunların% 2.6'sına (n=2) hafif GÖR,% 18.4'ü (n=14) orta GÖR ve% 38.2'si (n=29) şiddetli GÖR tanısı konuldu. Eşlik eden anatomik patolojiler şunlardı: malrotasyon (% 5.3), opere özofagus atrezisi ve diyafragma hernisi (% 2.6), organoaksiyel volvulus ve preplorik veb (% 1.3). Üst gastrointestinal floroskopi istem nedenleri% 40.8 (n=31) 'de dirençli kusma,% 10.5 (n=8)' de aralıklı kusma ve% 11.8 (n=9) öksürüktü. En sık eşlik eden patolojiler % 6.6'da (n=5) prematürite ve büyüme geriliği idi. 1 yaşından küçüklerin% 74.4'üne GÖR tanısı konulurken, bu oran 1 yaş ve üstü çocuklarda % 39.4 idi. 1 yaşından küçük hastalarda GÖR görülme sıklığı anlamlı derecede yüksek bulundu (p=0.002). Sürekli kusma olan hastaların % 74.2'sinde (n=23) GÖR, diğer nedenlerle üst gastrointestinal floroskopi uygulanan hastaların % 48.9'unda (n=22) GÖR mevcuttu. Bu fark da istatistiksel olarak anlamlıydı (p=0.027). Sonuç: Gastroözofageal reflü hastalığından şüphelenilen durumlarda, hasta 1 yaşından küçükse veya sürekli kusma varsa, üst gastrointestinal sistem floroskopisi tanıyı doğrulamak için yararlı olabilir. Bununla birlikte, anatomik bozukluklar önerilen UGF'lerin çok azında tespit edilebilmiştir. Bu bakış açısından, klinisyenlerin radyasyona bağlı riskler ve prosedür zorlukları göz önünde bulundurularak UGF'yi önermeleri uygun olacaktır.

Anahtar Kelimeler:

Gastrointestinal Sistem, Üst Gastrointestinal Endoskopi, Gastroözofageal Reflü

Factors Affecting The Diagnosis Of Gastroesophageal Reflux In Pediatric Patients Undergoing Upper Gastrointestinal Fluoroscopy

Objective: The aim of this study was to evaluate the results of upper gastrointestinal fluoroscopy in infants and children and to investigate factors affecting results and the diagnosis of gastroesophageal reflux (GER). Material and Methods: Patients between the ages of 1 month and 18 years who underwent upper gastrointestinal fluoroscopy at the Radiology Department of Dr. Sami Ulus Research and Training Hospital between January 1, 2018 and December 31, 2018 were included in the study. The files of the patients were reviewed retrospectively. Results: Of the 76 patients who underwent upper gastrointestinal fluoroscopy, 46.1% were male and median age was 10 months. Among these, 2.6% (n=2) were diagnosed with mild GER, 18.4% (n=14) with moderate GER, and 38.2% (n=29) with severe GER. The accompanying anatomic pathologies were: malrotation (5.3%), operated esophageal atresia and diaphragmatic hernia (2.6%), organoaxial volvulus and prepyloric web (1.3%). Reasons of requesting upper gastrointestinal fluoroscopy were persistent vomiting in 40.8% (n=31), intermittent vomiting in 10.5% (n=8), and coughing in 11.8% (n=9). The most common accompanying pathologies were prematurity and growth retardation in 6.6% (n=5). 74.4% of those younger than 1 year of age were diagnosed with GER, while this percentage was 39.4% in those aged 1 year or older. The incidence of GER in patients younger than 1 year of age was found to be significantly higher (p=0.002). GER was present in 74.2% (n=23) of patients who had persistent vomiting, while it was present in 48.9% (n=22) of patients who underwent upper gastrointestinal fluoroscopy for other reasons. This difference was also statistically significant (p=0.027). Conclusion: In cases where gastroesophageal reflux disease is suspected, if the patient is younger than 1 year of age or has persistent vomiting, upper gastrointestinal fluoroscopy may be useful to confirm the diagnosis. However, anatomical disorder can be detected in very few of the recommended UGF. From this point of view, it would be more appropriate for clinicians to recommend UGF in more suitable cases considering radiation related risks and procedure difficulties.

Keywords:

Gastrointestinal System, Upper Gastrointestinal Endoscopy, Gastroesophageal Reflux,

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