Pediatric Gastroesophageal Reflux

Etiology:
— Laxity of the gastroesophageal sphincter
— Gastric outlet obstruction
Imaging UpperGI:
— Contrast refluxing from stomach into esophagus
— Note: Limitation is the UpperGI study is only assessing for reflux for a few minutes out of a 24 hour day
DDX: Gastric outlet obstruction
Complications: Aspiration pneumonia, esophagitis resulting in esophageal strictures
Treatment: Positioning during feeding, medicine, Nissen fundoplication
Clinical:
— Present with vomiting with feeds or recurrent pneumonia
— Gold standard for diagnosis of gastroesophageal reflux is esophageal pH probe for 24 hours

Radiology Cases of Gastroesophageal Reflux

Radiology Cases of Esophageal pH Probe in Correct Position

CXR of correct position of esophageal pH probe sensor / measurement lead — CXR AP shows the tip of the nasogastric tube to be in the stomach. The position of the esophageal pH probe sensor / measurement lead (the radiolucent cylinder with the radiopaque stripe in the center of it) is 3-5 cm above the gastroesophageal junction.

CXR of pH probe — CXR AP shows a catheter with markers on it projecting within the esophagus which represents a pH probe whose sensor port, which appears as a minus (-) sign, is in appropriate position 3-5 cm above the gastroesophageal junction

Radiology Cases of Gastroesophageal Reflux That is Physiologic

UGI of gastroesophageal reflux — AP sequential images from an upper GI exam show contrast flowing in a retrograde manner from the stomach back up into the esophagus, reaching ultimately the level of the thoracic inlet (not shown).

Upper GI of aspiration due to gastroesophageal reflux — Upper GI exam shows a markedly distended stomach with marked gastroesophageal reflux rising to the level of the oropharynx and entering into the trachea clearly outlining the trachea to the right of the esophagus on the AP image (left) and anterior to the esophagus on the lateral image (right).

Radiology Cases of Gastroesophageal Reflux Due To Duodenal Obstruction From Malrotation and Midgut Volvulus

Upper GI of malrotation with midgut volvulus — AP image from an upper GI shows complete obstruction of the duodenum at the junction of the second and third parts of the duodenum and associated massive gastroesophageal reflux. A final image taken 5 minutes later was unchanged.

Radiology Cases of Gastroesophageal Reflux Causing Esophagitis and Esophageal Stricture

Upper GI of esophagitis and esophageal stricture from gastroesophageal reflux — Lateral spot image from an upper GI shows multiple small ulcerations in the esophageal mucosa and a fixed tight narrowing of the distal esophagus in the middle of the image which never opened up during the exam. Gastroesohageal reflux was also demonstrated throughout the exam

Endoscopy Cases of Pediatric Gastroesophageal Reflux

Endoscopy images of esophagitis due to gastroesophageal reflux — Endoscopic images show the inflammation and ulceration of esophagitis throughout the esophagus.