In 30 young children suspected of gastroesophageal reflux (GER), the G-E junction was examined with ultrasonography directly after a feeding while these children were on overnight extended esophageal pH monitoring (EEpHM) (32 simultaneous ultrasound/EEpHM studies). The two tests showed 81% to 84% agreement in the detection of the presence or absence of GER, depending on whether the whole period of EEpHM or only the part of it covering the ultrasound observation period were used as the standard. The discrepancies between the two tests were explained by the much longer monitoring period of EEpHM compared to ultrasonography and the inability of EEpHM to show reflux of neutralized gastric contents directly after milk feedings. The two studies probably measure different aspects of clinically significant reflux and must be correlated with the clinical symptoms. Morphological findings associated with significant reflux were (1) a short intraabdominal part of the esophagus, (2) a rounded gastroesophageal angle, and (3) a "beak" at the gastroesophageal junction. Barium meal findings confirmed these sonographic signs, indicating a sliding hiatal hernia of the distal esophagus, either fixed or intermittent. Ultrasonography can be recommended as a useful and physiological screening test to demonstrate clinically significant GER and a predisposing hiatal hernia of the esophagus in symptomatic children. Indexing Words:
Children, gastrointestinal tract * Esophagus, reflux -Stomach, reflux * Hernia, hiatal * Gastrointestinal tract, ultrasound studies Gastroesophageal reflux (GER) is a common disorder in infants and children. In the great majority it constitutes a "physiological." event and is of little clinical However, this often apparently benign and self-limiting disorder is now increasingly being recogniz,ed as a cause of failure to thrive, extreme irritability, unusual posturing, esophagitis, chronic blood loss, esophageal stricture, recurrent pneumonia, reactive airway disease, and possibly apnea of infancy even in the absence of overt e m e s i ~. ~. ~ Considerable confusion exists; over what constitutes significant GER and how best to diagnose it. The barium upper gastrointestinal study From the Departments of *Diagnostic Radiology and the