Evaluating the yield of gastrointestinal testing in pediatric patients in aerodigestive clinic

Emily M. DeBoer*, Sarah Kinder, Alison Duggar, Jeremy D. Prager, Jason Soden, Robin R. Deterding, Amanda G. Ruiz, Emily L. Jensen, Jason Weinman, Todd Wine, John Edward Fortunato, Joel A. Friedlander

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: To improve understanding of the interrelatedness of airway and esophageal diagnoses by evaluating the yield of procedural and radiographic testing of the gastrointestinal tract in children with airway conditions by their referring diagnoses in a pediatric aerodigestive clinic. Methods: A retrospective chart review of all 325 patients seen in the aerodigestive program from 2010 to 2013 was performed in a single academic medical center. Demographics and results from esophagogastroduodenoscopies with biopsies (EGD), upper gastrointestinal fluoroscopy studies (UGI), and pH multichannel intraluminal impedance probe (pH-MII) performed within 30 days of the clinic visit were evaluated according to presenting diagnoses. Results: Mean patient age was 3.15 years (range 0.15-24 years) and 41.2% were born premature. 189/325 (58.1%) were on acid suppression. A total of 295 EGD, 193 pH-MII, and 54 UGI were performed. The most common diagnosis with an abnormal pH-MII was asthma. The most common diagnoses with an abnormal EGD were feeding difficulty and tracheal esophageal fistula/ esophageal atresia (TEF/EA). EGDs were normal in 188/295 (63.7%), while 39/295 (13.2%) demonstrated esophagitis, and 22/295 (7.5%) had >15 esophageal eosinophils per high power field. The majority of pH-MII (144/193 [74.6%]) and UGI (47/54 [87%]) were normal. Conclusions: Children with feeding difficulty, TEF/EA, and asthma were the mostly likely to have a histologic abnormality on EGD or an abnormal pH-MII. The majority of children were previously prescribed acid suppression medication and had a referring diagnosis of gastroesophageal reflux disease but were subsequently found to have normal evaluation. Prospective studies are needed to optimize care of this population.

Original languageEnglish (US)
Pages (from-to)1517-1524
Number of pages8
JournalPediatric Pulmonology
Volume53
Issue number11
DOIs
StatePublished - Nov 1 2018

Fingerprint

Electric Impedance
Pediatrics
Esophageal Fistula
Esophageal Atresia
Asthma
Digestive System Endoscopy
Acids
Esophagitis
Fluoroscopy
Ambulatory Care
Gastroesophageal Reflux
Eosinophils
Gastrointestinal Tract
Demography
Prospective Studies
Biopsy
Population

Keywords

  • asthma
  • cough
  • gastroesophageal reflux
  • imaging
  • tracheoesophageal fistula

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pulmonary and Respiratory Medicine

Cite this

DeBoer, E. M., Kinder, S., Duggar, A., Prager, J. D., Soden, J., Deterding, R. R., ... Friedlander, J. A. (2018). Evaluating the yield of gastrointestinal testing in pediatric patients in aerodigestive clinic. Pediatric Pulmonology, 53(11), 1517-1524. https://doi.org/10.1002/ppul.24170
DeBoer, Emily M. ; Kinder, Sarah ; Duggar, Alison ; Prager, Jeremy D. ; Soden, Jason ; Deterding, Robin R. ; Ruiz, Amanda G. ; Jensen, Emily L. ; Weinman, Jason ; Wine, Todd ; Fortunato, John Edward ; Friedlander, Joel A. / Evaluating the yield of gastrointestinal testing in pediatric patients in aerodigestive clinic. In: Pediatric Pulmonology. 2018 ; Vol. 53, No. 11. pp. 1517-1524.
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abstract = "Objective: To improve understanding of the interrelatedness of airway and esophageal diagnoses by evaluating the yield of procedural and radiographic testing of the gastrointestinal tract in children with airway conditions by their referring diagnoses in a pediatric aerodigestive clinic. Methods: A retrospective chart review of all 325 patients seen in the aerodigestive program from 2010 to 2013 was performed in a single academic medical center. Demographics and results from esophagogastroduodenoscopies with biopsies (EGD), upper gastrointestinal fluoroscopy studies (UGI), and pH multichannel intraluminal impedance probe (pH-MII) performed within 30 days of the clinic visit were evaluated according to presenting diagnoses. Results: Mean patient age was 3.15 years (range 0.15-24 years) and 41.2{\%} were born premature. 189/325 (58.1{\%}) were on acid suppression. A total of 295 EGD, 193 pH-MII, and 54 UGI were performed. The most common diagnosis with an abnormal pH-MII was asthma. The most common diagnoses with an abnormal EGD were feeding difficulty and tracheal esophageal fistula/ esophageal atresia (TEF/EA). EGDs were normal in 188/295 (63.7{\%}), while 39/295 (13.2{\%}) demonstrated esophagitis, and 22/295 (7.5{\%}) had >15 esophageal eosinophils per high power field. The majority of pH-MII (144/193 [74.6{\%}]) and UGI (47/54 [87{\%}]) were normal. Conclusions: Children with feeding difficulty, TEF/EA, and asthma were the mostly likely to have a histologic abnormality on EGD or an abnormal pH-MII. The majority of children were previously prescribed acid suppression medication and had a referring diagnosis of gastroesophageal reflux disease but were subsequently found to have normal evaluation. Prospective studies are needed to optimize care of this population.",
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DeBoer, EM, Kinder, S, Duggar, A, Prager, JD, Soden, J, Deterding, RR, Ruiz, AG, Jensen, EL, Weinman, J, Wine, T, Fortunato, JE & Friedlander, JA 2018, 'Evaluating the yield of gastrointestinal testing in pediatric patients in aerodigestive clinic', Pediatric Pulmonology, vol. 53, no. 11, pp. 1517-1524. https://doi.org/10.1002/ppul.24170

Evaluating the yield of gastrointestinal testing in pediatric patients in aerodigestive clinic. / DeBoer, Emily M.; Kinder, Sarah; Duggar, Alison; Prager, Jeremy D.; Soden, Jason; Deterding, Robin R.; Ruiz, Amanda G.; Jensen, Emily L.; Weinman, Jason; Wine, Todd; Fortunato, John Edward; Friedlander, Joel A.

In: Pediatric Pulmonology, Vol. 53, No. 11, 01.11.2018, p. 1517-1524.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Evaluating the yield of gastrointestinal testing in pediatric patients in aerodigestive clinic

AU - DeBoer, Emily M.

AU - Kinder, Sarah

AU - Duggar, Alison

AU - Prager, Jeremy D.

AU - Soden, Jason

AU - Deterding, Robin R.

AU - Ruiz, Amanda G.

AU - Jensen, Emily L.

AU - Weinman, Jason

AU - Wine, Todd

AU - Fortunato, John Edward

AU - Friedlander, Joel A.

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Y1 - 2018/11/1

N2 - Objective: To improve understanding of the interrelatedness of airway and esophageal diagnoses by evaluating the yield of procedural and radiographic testing of the gastrointestinal tract in children with airway conditions by their referring diagnoses in a pediatric aerodigestive clinic. Methods: A retrospective chart review of all 325 patients seen in the aerodigestive program from 2010 to 2013 was performed in a single academic medical center. Demographics and results from esophagogastroduodenoscopies with biopsies (EGD), upper gastrointestinal fluoroscopy studies (UGI), and pH multichannel intraluminal impedance probe (pH-MII) performed within 30 days of the clinic visit were evaluated according to presenting diagnoses. Results: Mean patient age was 3.15 years (range 0.15-24 years) and 41.2% were born premature. 189/325 (58.1%) were on acid suppression. A total of 295 EGD, 193 pH-MII, and 54 UGI were performed. The most common diagnosis with an abnormal pH-MII was asthma. The most common diagnoses with an abnormal EGD were feeding difficulty and tracheal esophageal fistula/ esophageal atresia (TEF/EA). EGDs were normal in 188/295 (63.7%), while 39/295 (13.2%) demonstrated esophagitis, and 22/295 (7.5%) had >15 esophageal eosinophils per high power field. The majority of pH-MII (144/193 [74.6%]) and UGI (47/54 [87%]) were normal. Conclusions: Children with feeding difficulty, TEF/EA, and asthma were the mostly likely to have a histologic abnormality on EGD or an abnormal pH-MII. The majority of children were previously prescribed acid suppression medication and had a referring diagnosis of gastroesophageal reflux disease but were subsequently found to have normal evaluation. Prospective studies are needed to optimize care of this population.

AB - Objective: To improve understanding of the interrelatedness of airway and esophageal diagnoses by evaluating the yield of procedural and radiographic testing of the gastrointestinal tract in children with airway conditions by their referring diagnoses in a pediatric aerodigestive clinic. Methods: A retrospective chart review of all 325 patients seen in the aerodigestive program from 2010 to 2013 was performed in a single academic medical center. Demographics and results from esophagogastroduodenoscopies with biopsies (EGD), upper gastrointestinal fluoroscopy studies (UGI), and pH multichannel intraluminal impedance probe (pH-MII) performed within 30 days of the clinic visit were evaluated according to presenting diagnoses. Results: Mean patient age was 3.15 years (range 0.15-24 years) and 41.2% were born premature. 189/325 (58.1%) were on acid suppression. A total of 295 EGD, 193 pH-MII, and 54 UGI were performed. The most common diagnosis with an abnormal pH-MII was asthma. The most common diagnoses with an abnormal EGD were feeding difficulty and tracheal esophageal fistula/ esophageal atresia (TEF/EA). EGDs were normal in 188/295 (63.7%), while 39/295 (13.2%) demonstrated esophagitis, and 22/295 (7.5%) had >15 esophageal eosinophils per high power field. The majority of pH-MII (144/193 [74.6%]) and UGI (47/54 [87%]) were normal. Conclusions: Children with feeding difficulty, TEF/EA, and asthma were the mostly likely to have a histologic abnormality on EGD or an abnormal pH-MII. The majority of children were previously prescribed acid suppression medication and had a referring diagnosis of gastroesophageal reflux disease but were subsequently found to have normal evaluation. Prospective studies are needed to optimize care of this population.

KW - asthma

KW - cough

KW - gastroesophageal reflux

KW - imaging

KW - tracheoesophageal fistula

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DeBoer EM, Kinder S, Duggar A, Prager JD, Soden J, Deterding RR et al. Evaluating the yield of gastrointestinal testing in pediatric patients in aerodigestive clinic. Pediatric Pulmonology. 2018 Nov 1;53(11):1517-1524. https://doi.org/10.1002/ppul.24170