Background:Recently, association between the length of abdominal esophagus and increased risk for gastro-esophageal reflux disease has been hypothesized.
Objectives:The aim of the present study was to provide sonographic measurements of the abdominal esophagus length in premature neonates with and without GERD and to investigate its diagnostic value to assess GERD in comparison with clinical diagnosis of disease.
Patients and Methods:In a cross-sectional study, 75 consecutive premature neonates aged less than 30 days with birth weights of less than 2000 grams hospitalized in NICU ward of the Mahdieh hospital in Tehran in 2013 were included in the study. The certain diagnosis of GERD was based on clinical manifestations. The presence of GERD and also measurement of the abdominal esophageal length was assessed by portable sonography using SIUI sonography device.
Results:Clinically, reflux was diagnosed in 15 neonates (20.0%). It was also diagnosed in 20 cases (26.7%) by sonography assessment yielding a sensitivity of 86.7%, a specificity of 88.3%, a positive predictive value of 65.0%, a negative predictive value of 96.4%, and an accuracy of 88% for this diagnostic device. The mean of the length of abdominal esophagus was 15.19 + 4.10 mm (ranging from 8 to 27 mm). There was a strong positive association of the length of abdominal esophagus with neonatal birth weight (r = 0.553, P < 0.001), and also with gestational age (r = 0.491, P < 0.001). Furthermore, those neonates with underlying jaundice and those with sepsis had significantly shorter esophagus than those with RDS. Those with clinical diagnosis of reflux had significantly shorter abdominal esophagus than neonates without reflux (11.47 + 1.36 mm versus 16.12 + 4.03 mm, P < 0.001). In a multivariate linear regression model, shorter abdominal esophagus was shown to be related to the presence of reflux (beta = 2.764, SE = 1.068, P = 0.012).
Conclusions:Shorter abdominal esophagus in premature neonates is associated with increased risk for GERD that is more highlighted in those neonates with lower birth weight and lower gestational age. Sonography has a high value for assessment of both GERD and also anatomical state of abdominal esophagus in premature neonates.
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