Prevalence of Non-erosive Esophageal Phenotypes in Children: A European Multicenter Study
- Author:
Elisa BLASI
1
;
Ettore STEFANELLI
;
Renato TAMBUCCI
;
Silvia SALVATORE
;
Paola De ANGELIS
;
Paolo QUITADAMO
;
Claudia PACCHIAROTTI
;
Giovanni Di NARDO
;
Fanj CROCCO
;
Enrico FELICI
;
Valentina GIORGIO
;
Nicoletta STAROPOLI
;
Simona SESTITO
;
Efstratios SALIAKELLIS
;
Osvaldo BORRELLI
;
Licia PENSABENE
Author Information
- Publication Type:Original Article
- From:Journal of Neurogastroenterology and Motility 2023;29(2):156-165
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background/Aims:Since available data on pediatric non-erosive esophageal phenotypes (NEEPs) are scant, we investigated their prevalence and the phenotype-dependent treatment response in these children.
Methods:Over 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.
Results:Out 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.
Conclusions:FH 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.
