Symptoms and Reflux in Infants: Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R)-Utility for Symptom Tracking and Diagnosis.
Summary of "Symptoms and Reflux in Infants: Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R)-Utility for Symptom Tracking and Diagnosis."
Answering a need for a thoroughly validated infant gastroesophageal reflux questionnaire, the Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R) was designed, refined, and validated using state-of-the-art psychometric methods. Diagnostic and evaluative (tracking) validity was identified. However, perplexing results of some clinical trials using the I-GERQ-R for diagnosis prompted analysis of possible reasons, including ambiguities in defining symptomatic gastroesophageal reflux disease (GERD) and aspects of the validation process. Symptomatic GERD is defined by "troublesomeness" of symptoms and attribution of their causation to reflux-two crucial issues. Methods of quantifying symptom-reflux associations are described and their limitations identified. The location of "symptomatic esophageal GERD" in the continuum of erosive GERD, histologic GERD, and nonerosive reflux disease is indicated, with the last including "suberosive," "premicroscopic," and "functional heartburn" subcategories. Another category is defined solely by surrogate measures of propensity to GERD (e.g., acid exposure thresholds defined on esophageal pH monitoring). During diagnostic validation of the Infant Gastroesophageal Reflux Questionnaire (I-GERQ) instruments, asymptomatic normals were contrasted with symptomatic GERD infants (who also tested positive with esophageal histology and esophageal pH monitoring). However, the diagnostic validation did not attempt to distinguish symptomatic GERD infants from symptomatic infants without GERD. The I-GERQ-R is thus adequately sensitive to be used diagnostically to screen infants for symptom burden, but should probably be supplemented by other, perhaps invasive, testing to assure appropriate specificity. The I-GERQ-R's validation for evaluative properties, however, supports its use for tracking symptoms within clinical trials.
Pediatric Gastroenterology, University of Pittsburgh School of Medicine, 303 Church Lane, Pittsburgh, PA, 15238, USA, email@example.com.
This article was published in the following journal.
Name: Current gastroenterology reports
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20857238
- DOI: http://dx.doi.org/10.1007/s11894-010-0140-1
Medical and Biotech [MESH] Definitions
Retrograde bile flow. Reflux of bile can be from the duodenum to the stomach (DUODENOGASTRIC REFLUX); to the esophagus (GASTROESOPHAGEAL REFLUX); or to the PANCREAS.
Chronic ESOPHAGITIS characterized by esophageal mucosal EOSINOPHILIA. It is diagnosed when an increase in EOSINOPHILS are present over the entire esophagus. The reflux symptoms fail to respond to PROTON PUMP INHIBITORS treatment, unlike in GASTROESOPHAGEAL REFLUX DISEASE. The symptoms are associated with IgE-mediated hypersensitivity to food or inhalant allergens.
Esophageal Motility Disorders
Disorders affecting the motor function of the UPPER ESOPHAGEAL SPHINCTER; LOWER ESOPHAGEAL SPHINCTER; the ESOPHAGUS body, or a combination of these parts. The failure of the sphincters to maintain a tonic pressure may result in gastric reflux of food and acid into the esophagus (GASTROESOPHAGEAL REFLUX). Other disorders include hypermotility (spastic disorders) and markedly increased amplitude in contraction (nutcracker esophagus).
GASTROESOPHAGEAL REFLUX wherein the retrograde flow passes through the UPPER ESOPHAGEAL SPHINCTER
A condition with damage to the lining of the lower ESOPHAGUS resulting from chronic acid reflux (ESOPHAGITIS, REFLUX). Through the process of metaplasia, the squamous cells are replaced by a columnar epithelium with cells resembling those of the INTESTINE or the salmon-pink mucosa of the STOMACH. Barrett's columnar epithelium is a marker for severe reflux and precursor to ADENOCARCINOMA of the esophagus.
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