Diagnosis of Peptic Esophagitis in Children; Ultrasound versus Endoscopy

Background/Objectives: To investigate the value of transabdominal sonography for evaluation of esophagitis in children. Materials and Methods: A total of 74 children with the clinical suspicion of esophagitis underwent transabdominal sonography of the gastroesophageal junction. Thicknesses of the anterior and posterior walls of the gastroesophageal junction were measured, as well as the thickness of the mucosa. This was followed by endoscopy and biopsy. Results: In histopathologic examination 44 cases were diagnosed as having esophagitis (diseased group) and 30 were reported normal (normal group). The mean wall thickness was significantly higher in the diseased group. Sonography based on wall thickness using cut-off point of 6.9 mm had a sensitivity of 96%. Negative predictive value of 91% and accuracy of 84%. Sonography based on mucosal thickness using cut-off point of 1.8 mm had a sensitivity of 96%, negative predictive value of 81% and accuracy of 69%. Endoscopy had a sensitivity of 82%, negative predictive value 65% and accuracy of 69%. Despite the high accuracy of sonography, endoscopy due to its ability to perform biopsy cannot be superseded by sonography in evaluation of reflux esophagitis, but owing to high sensitivity and negative predictive value of sonography, it has the potential to be used as a screening test. Conclusion: In the clinical setting of reflux esophagitis in children, if TAS of the GEJ showed a GEJ wall thickness of 6.9 mm or less and the mucosal thickness of 1.8 mm or less, and if there is no gastroesophageal reflux noted on sonography, the patient should be considered as normal and no endoscopy is required. On the other hand, if the patient showed a thickness of the wall of the GEJ 7 mm or more, or a thickness of the mucosa of GEJ 2 mm or more on TAS, an endoscopy should be performed and a biopsy should be obtained.