Addition of pH-Impedance Monitoring to Standard pH Monitoring Increases the Yield of Symptom Association Analysis in Infants and Children with Gastroesophageal Reflux

Objective To assess the additional yield of combined multichannel intraluminal pH-impedance (pH-MII) monitoring compared with standard pH monitoring on gastroesophageal reflux (GER) symptom associations in infants and children. Study design In 80 patients, 24-hour ambulatory pH-MII monitoring was pe...

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Bibliographic Details
Published in:The Journal of pediatrics 2009-02, Vol.154 (2), p.248-252
Main Authors: Loots, Clara M., MsC, Benninga, Marc A., MD, PhD, Davidson, Geoffrey P., MBBS, MD, FRACP, Omari, Taher I., PhD
Format: Article
Language:English
Subjects:
Biological and medical sciences
Child, Preschool
Electric Impedance
Esophageal pH Monitoring
Esophagus
Esophagus - physiopathology
Gastric Acidity Determination
Gastroenterology. Liver. Pancreas. Abdomen
Gastroesophageal Reflux - physiopathology
General aspects
Humans
Infant
Medical sciences
Other diseases. Semiology
Pediatrics
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Summary:Objective To assess the additional yield of combined multichannel intraluminal pH-impedance (pH-MII) monitoring compared with standard pH monitoring on gastroesophageal reflux (GER) symptom associations in infants and children. Study design In 80 patients, 24-hour ambulatory pH-MII monitoring was performed. Tracings were analyzed with established pH-MII criteria. Symptoms of regurgitation and belching were excluded from analysis, because these were considered to be a direct consequence of GER. Standard GER-symptom correlation indices were calculated with: 1) standard pH monitoring; 2) MII detection of liquid and mixed bolus GER; 3) MII detection of all bolus GER (liquid, mixed, and gas); 4) pH-MII detection of all GER, including pH-only GER. Results Fifty patients (21 children) were included. MII detection of all bolus GER yielded a significantly greater number of patients who were symptom-positive, 36 (72%) compared with 25 (50%) with standard pH-monitoring ( P = .04). A positive symptom association was observed in 8 of 10 (80%) patients with pathological esophageal acid exposure and 28 of 40 (70%) patients with negative pH-findings. Conclusions A high proportion of patients with normal esophageal acid exposure had a positive symptom association on pH-MII monitoring. Including all MII-detected bolus GER and excluding pH-only GER for analysis optimizes the yield of GER-symptom associations in infants and children.
ISSN:0022-3476
1097-6833
DOI:10.1016/j.jpeds.2008.08.019