A 3-week-old child currently admitted to the hospital for pneumonia who gags and chokes during feedings
- Esophageal manometry
- 24-hour pH probe
- Upper GI endoscopy
- Upper GI fluoroscopy (upper GI series)
- Modified barium swallow
Explanation
An infant who gags and chokes while feeding may have an uncoordinated suck-swallow reflex, or may have significant gastroesophageal reflux. More rarely there may be an H-type tracheoesophageal fistula. A modified barium swallow with fluoroscopy allows direct visualization of the swallow reflex. In some situations during the modified barium swallow, the patient may be given different consistencies of food to document if thickened feeds decrease the dysphasia. A normal barium study does not, however, rule out a fistula.
The second patient’s story is concerning for peptic ulcer disease. An upper GI series may show findings suggestive of the diagnosis, but endoscopy is the preferred diagnostic method, as it allows biopsy for microscopy and culture, and direct visualization.
The third child may have gastroesophageal reflux, causing Sandifer syndrome, a condition in which infants will arch and become tonic to protect their airway from the refluxing gastric contents. While an upper GI series can sometime diagnose gastroesophageal reflux, esophageal pH probe is currently the preferred diagnostic test.