1. SCREENING OF GASTROESOPHAGEAL REFLUX IN CHILDREN First author: Liana Stanciu Coordinator: Professor Doctor Oana Marginean Coauthors : Cosmin Oprea and Maria Oana Marginean

2.  Gastroesophageal reflux disease (GERD) is one of the most common and frequent pathologies encountered in pediatrics and pediatric gastroenterology centers.  Gastroesophageal reflux occurs several times a day for infants, children, adolescents and adults when it is asymptomatic or it produces few symptoms.

3. W HY IS IT IMPORTANT TO ELABORATE A SCREENING TEST FOR THE EVOLUTION OF GASTROESOPHAGEAL REFLUX ? Gastroesophageal reflux + symptoms/complications with significant morbidity Gastroesophageal reflux disease

4.  Objective : To determine whether the proposed questionnaire is able to establish the gastroesophageal reflux in children.

5.  Material and Method :  analytic observational prospective study  50 pediatric pacients  2 questionnaires adapted to 2 groups : children aged 0 to 8 years and children over 8 years  questions based on age,gender and presence of significant symptoms

6. I F, IN THE LAST 7 DAYS OR MORE, BEFORE THE VISIT TO THE DOCTOR, YOUR CHILD, PRESENTED THE FOLLOWING SYMPTOMS :  weight loss  regurgitation or vomiting frequently  refusing food or irritability even if is hungry  crying during meals or 1 hour after eating  hiccups  nocturne coughing or wheezing without fever  stopping breathing or choking episodes  nausea or vomiting frequently  bitter or sour taste in the mouth  painful swallowing of food  epigastric pain  retrosternal burn  nocturne coughing or wheezing without fever Children aged 0 to 8 years Children over 8 years

7. Criterion for identification of gastroesophageal reflux disease in children : If the child has submitted at least 2 or more of the symptoms listed can be considered suspect of gastroesophageal reflux disease.

8. Presence of disease Absence of disease Total Children over 8 years14519 Children aged 0 to 8 years 102131 Total242650 p value = 0,008 < 0,05p value is highly statistically significant OR = 5.88 >1GERD is approximately 6 times more frequently in children over 8 years from the case group compared to the control group

10. VariableCase groupControl group p valueOR weight loss530,452,01 vomiting1060,222,38 refusing food730,163,15 crying200,22- hiccups430,691,53 nocturne coughing 1030,025,47 stopping breathing 530,452,01 bitter or sour taste 510,096,57 painful swallowing 910,00415 epigastric pain 610,048,3 retrosternal burn 600,008-

11.  Results : 1. The symptoms which are significantly correlated with the gastroesophageal reflux disease are:  nocturne coughing (p=0,02, OR=5,47)  painful swallowing (p<0,01, OR=15)  epigastric pain (p=0,04, OR=8,3) 2. Gastroesophageal reflux disease is more common in females (58%) and is approximately 6 times more frequently in children over 8 years from the case group compared to the control group (p<0,01,OR=5,88).

12.  Discussions:  nocturne coughing : p=0,02 and OR=5,47 OR=5,47 > 1 GERD is approximately 5 times more frequently in children from the case group in both age groups  painful swallowing : p=0,004 and OR=15 OR=15 > 1 GERD is 15 times more frequently in children over 8 years from the case group compared to the control group  epigastric pain : p=0,04 and OR=8,3 OR=8,3 > 1 GERD is approximately 8 times more frequently in children over 8 years from the case group compared to the control group

13. W HICH ARE THE ADVANTAGES OF USING THIS SCREENING TEST ?  non-invasive  easy to apply  requires low cost price  fast to use  may be applied continuously for suspicious cases  effective because it is able to detect early GERD in order to paediatric approach for investigations and expert consult

14.  Conclusions: 1. Gastroesophageal reflux disease is a condition which has become more frequent in children over the few years and is associated in this study with these symptoms: nocturne coughing, painful swallowing and epigastric pain. 2. Gastroesophageal reflux disease is more common in females and is more frequently in children over 8 years. 3.This screening test is a very useful tool for the diagnosis of gastroesophageal reflux because of its advantages.

15.  Bibliography :  http://www.sciencedirect.com/science/artic le/pii/S0021755713002027 http://www.sciencedirect.com/science/artic le/pii/S0021755713002027  http://www.naspghan.org/files/documents/ pdfs/position-papers/FINAL%20- %20JPGN%20GERD%20guideline.pdf http://www.naspghan.org/files/documents/ pdfs/position-papers/FINAL%20- %20JPGN%20GERD%20guideline.pdf

16. Thank you for your attention!