Importance of upper gastrointestinal series in children with gastroesophageal reflux

Midgut volvulus is a surgical emergency and occurs as a complication in patients with malrotation. The importance of an upper gastrointestinal series (UGI) in all patients with gastroesophageal reflux disease (GERD) is to rule out any anatomic abnormality precipitated by GERD. Of these abnormalities, "midgut volvulus" is the most catastrophic complication and occurs with intestinal malrotation and should be treated as a surgical emergency. Patients with intestinal malrotation present symptoms such as the following: gastric or bilious vomiting, GERD, nausea, anorexia, abdominal distension or intermittent chronic abdominal pain, constipation, diarrhea, bloody stools, and stunted growth. However, some patients may not demonstrate any of the above symptoms or be asymptomatic. Approximately 75% of patients with intestinal malrotation present features of GERD or vomiting bile, but in the remaining 25% of patients, GERD is characteristic of GI symptoms and may go unnoticed. In these patients, UGI series followed by intestinal transit remains the study of choice to rule out anatomic malformations or disorders of the digestive tract such as intestinal malrotation or volvulus.