小儿胃食管反流病诊断进展

小儿胃食管反流病（GERD）临床表现多样,有典型症状、非典型症状和消化道外症状之分。在基层医院诊断一般依赖病史、典型症状和体格检查。反流诊断问卷可用于初筛。食管胃钡餐造影能显示胃肠道的解剖结构异常。食管pH监测、Bravo胶囊无线pH监测、Bilitec2000胆红素监测、阻抗结合pH测定等可证实有无反流。胃镜检查和食管黏膜活检常作为诊断反流性食管炎和Barrett食管的首选方法。食管动力功能检查有助于了解GER的病理生理基础和发病机制。胃食管B型超声和食管核素测定可用于评价胃排空,而核素扫描还可确认有无肺部吸入。临床上必须根据需要选择适当的检查方法和诊断程序,提高诊断水平。

Advances of diagnosis in children with gastroesophageal reflux disease

The clinical manifestations of gastroesophageal reflux disease(GERD)in children are various,inclu-ding typical,atypical and supra-esophageal symptoms.In grass-root hospitals,GERD is normally diagnosed with history,typical symptoms and physical examinations.Reflux diagnostic questionnaires serve as primary screening.The upper gastrointestinal barium meal imaging is useful for evaluating the presence of anatomic abnormalities.Esophageal pH monito-ring,Bravo capsule wireless pH monitoring,Bilitec 2000 bilirubin monitoring,combined pH and multichannel intraluminal impedance measurement are valid and reliable methods for detecting acidic and non-acidic refluxes.Endoscopy and esophageal biopsy for histopathological examination can assess the presence and severity of esophagitis,stricture and Barrett's esophagus.Esophageal motor function is helpful to determine pathogenesis and pathophysiology of GERD.Gastro-esophageal scintigraphy and ultrasonography are useful for the assessment of gastric emptying,while scintigraphy seems to be a key element in the evaluation of pulmonary aspiration.Therefore,it is important to improve the diagnostic level of GERD by selecting appropriate diagnostic tests and approaches according to the individual clinical situation.