Is the Diagnostic Trial with Proton Pump Inhibitors Reasonable for School Age Children with Gastroesophageal Reflux Symptoms?

Purpose: On the basis of evidence, we aimed to reevaluate the necessity of the empirical proton pump inhibitor (PPI) trial for children with suspected gastroesophageal reflux disease (GERD). Methods: We analyzed the frequency of GERD in 85 school-age children with gastroesophageal reflux (GER) symptoms, who received 24-hour esophageal pH monitoring and/or tipper endoscopy. According to the reflux index (RI), the children were classified into normal (RI <5%), intermediate (5%<= RI <10%), or abnormal (RI >= 10%) groups. Results: Fifty six were female and 29 were male. Their mean age was 12.6 +/- 0.5 (+/- standard deviation) years (range: 6.8-18.6). The RI analysis showed that the normal group included 76 patients (89.4%), the intermediate group included 6 patients (7.1%), and the abnormal group included 3 patients (3.5%). The DeMeester score was 5.93 +/- 4.65, 14.68 +/- 7.86 and 40.37 +/- 12.96 for the normal, intermediate and abnormal group, respectively (p=0.001). The longest reflux time was 5.56 +/- 6.00 minutes, 9.53 +/- 7.84 minutes, and 19.46 +/- 8.35 minutes in the normal, intermediate, and abnormal group, respectively (p=0.031). Endoscopic findings showed reflux esophagitis in 7 patients. On the basis of the Los Angeles Classification of Esophagitis, 5 of these patients were included in group A, 1 patient, in group B and 1 patient, in group C. Conclusion: The incidence of GERD was very low in school-age children with GER symptoms. Therefore, injudicious diagnostic PPI trials would be postponed until the actual prevalence of GERD is verified in future prospective studies.