Upper gastrointestinal radiography study rol in the vomiting children evaluation

Abstract

The role of the upper gastrointestinal radiographic study (UGIR) in the evaluation of children with regurgitation/vomiting has not been well defined in Chile, in spite of its importance in the diagnosis of gastroesophageal reflux (GER). GER is, most cases, a physiological condition manifested by regurgitation and/or vomiting in infants. The American Academy of Pediatrics has insisted on this point and has stated that the UGIR is a useful study in order to rule out an anatomical cause of vomiting when there are basis to suspect it, but in most cases of regurgitation/vomiting, a careful clinical history and physical examination with consideration on anthropometrical index of the child are sufficient to make the diagnosis and begin therapy. However, in many places radiologists are performing UGIR that are, in most cases, unnecessary and risky, with results badly interpreted. A few years ago a new phenomenon was observed in Chile in which an increasing number of mothers of infants less than one year-old were given extended work absence by virtue of the presence of (radiologically proven) gastroesophageal reflux in their children, plus a medical certificate supporting the diagnosis. For this reason, in most children referred to us for an UGIR study, there is not a real medical indication for requesting this test and, in a significant number of cases, this procedure is requested in order to assume medically an innocent symptom and therefore, obtain a “medical license” based on the results of the UGIR. In almost all cases, an anatomical condition is not found as the cause of vomiting. The use of UGIR in children is usually misunderstood, its execution can be operator-dependent and the results easily mistaken. A rational consensus protocol for the execution and interpretation of this procedure is lacking. On the other side, a change in current laws should be considered to correct legal issues in health areas.