Sonographic Measurements of Subdiaphragmatic Length, Diameter, and Diameter to Length Ratio of Esophagus in Gastroesophageal Reflux Disease Diagnosis in Children

Abstract

Gastroesophageal reflux disease (GERD) is a common condition among infants and young children. In this age-group, in particular, this condition needs to be diagnosed and treated as early as possible, because any delay may lead to unwanted consequences in terms of their growth and development. Although ultrasonography has been claimed as a sensitive and accurate diagnostic modality, it is time-consuming and difficult to perform in young children. This study aimed to evaluate correlation of some sonographic anatomical parameters of distal esophagus with results of classic sonography in diagnosis of GERD in infants and children. In this cross-sectional analytic-descriptive study, 282 infants and children were recruited. Based on the results of gray-scale conventional sonography, GERD was diagnosed in 185 cases. Length of the subdiaphragmatic esophagus, distal esophageal diameter and wall thickness, and diameter to length ratio were documented by ultrasound and compared between the groups with and without GERD. One hundred and thirty nine boys and 143 girls with a mean age of 16.78 +/- 20.99 (range: 1-144) months were enrolled in this study. The length of subdiaphragmatic esophagus was significantly lower in the cases with GERD, while the distal esophageal wall thickness and the diameter to length ratio were significantly higher in the same group. Among the studied sonographic variables, diameter to length ratio was the best indirect indicator of GERD with an optimal cut-off point of 0.45 (sensitivity: 61.1%, specificity: 57.7%). The length of subdiaphragmatic esophagus was predictive of GERD only in the age-group of 12-60 months with low sensitivity and specificity (<42%). This study showed that only the diameter to length ratio of the subdiaphragmatic esophagus might be used to predict GERD among children with limited efficiency.