KAI-CHI CHANGJIA-FENG WUWEI-CHUNG HSUBOR-RU LINHUEY-LING CHENYEN-HSUAN NI2020-03-102020-03-1020141932-6203https://www.scopus.com/inward/record.uri?eid=2-s2.0-84907192410&doi=10.1371%2fjournal.pone.0107954&partnerID=40&md5=c80c0a049b507fc495d9125a3faadc03https://scholars.lib.ntu.edu.tw/handle/123456789/475089Background: Gastroesophageal flap valve (GEFV) endoscopic grading is reported to be associated with gastroesophageal reflux disease (GERD) in adults; however its role in pediatric groups remains unknown. This study aimed to investigate the significance of GEFV grading and the associations to multichannel intraluminal impedance and pH monitoring (MII-pH) in children with GERD.Methods: A total of 48 children with GERD symptoms who received esophagogastroduodenoscopy and MII-pH monitoring were enrolled. The degree of GEFV was graded from I to IV according to the Hill classification, and classified into two groups:normal GEFV (Hill grades I and II), and abnormal GEFV (Hill grades III and VI). Endoscopic findings and MII-pH monitoring were analyzed among the groups.Results: Thirty-six patients had normal GEFV while 12 had abnormal GEFV. The presence of erosive esophagitis was significantly more common in the patients with abnormal GEFV (p = 0.037, OR 9.84, 95% CI 1.15-84.42). Pathological acidic gastroesophageal reflux (GER) determined by MII-pH was more prevalent in the patients with loosened GEFV geometry (p = 0.01, OR 7.0, 95% CI 1.67-27.38). There were significant positive correlations between GEFV Hill grading I to IV and the severity of erosive esophagitis (r = 0.49, p,< 001), percentage of supine acid reflux (r = 0.37, p = 0.009), percentage of total acid reflux (r = 0.3284, p = 0.023), and DeMeester score (r = 0.36, p = 0.01) detected by pH monitoring. In the impedance study, GEFV Hill grading also positively correlated to median number of acid reflux events (r = 0.3015, p = 0.037).Conclusions: GEFV dysfunction highly associated with acid GER and severe erosive esophagitis. An abnormal GEFV is a signof acid GER in children. ? 2014 Chang et al.[SDGs]SDG3proton pump inhibitor; Article; child; clinical article; clinical evaluation; controlled study; DeMeester score; digestive tract endoscopy; disease classification; esophageal pH monitoring; esophagogastroduodenoscopy; female; gastric pH monitoring; gastroenterological procedure; gastroesophageal flap valve endoscopic grading; gastroesophageal reflux; Hill classification; human; male; preschool child; reflux esophagitis; scoring system; treatment response; adolescent; digestive tract endoscopy; gastroesophageal reflux; infant; lower esophagus sphincter; pathology; pH; prevalence; severity of illness index; treatment outcome; Adolescent; Child; Child, Preschool; Endoscopy, Digestive System; Esophageal Sphincter, Lower; Female; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Infant; Male; Prevalence; Proton Pump Inhibitors; Severity of Illness Index; Treatment Outcomejournal article10.1371/journal.pone.0107954252333502-s2.0-84907192410