The Journal of Pediatrics
Volume 154, Issue 2 , Pages 248-252, February 2009

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

  • Clara M. Loots, MsC

      Affiliations

    • Academic Medical Centre, Amsterdam, The Netherlands
    • Corresponding Author InformationReprint requests: Clara Maria Loots, Motility Center, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
  • ,
  • Marc A. Benninga, MD, PhD

      Affiliations

    • Academic Medical Centre, Amsterdam, The Netherlands
  • ,
  • Geoffrey P. Davidson, MBBS, MD, FRACP

      Affiliations

    • Women's and Children's Hospital, Adelaide, Australia
    • Department of Paediatrics, University of Adelaide, Adelaide, Australia
  • ,
  • Taher I. Omari, PhD

      Affiliations

    • Women's and Children's Hospital, Adelaide, Australia
    • Department of Paediatrics, University of Adelaide, Adelaide, Australia

Received 25 May 2008; received in revised form 7 July 2008; accepted 8 August 2008. published online 29 September 2008.

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.

Abbreviations: GER, Gastroesophageal reflux, pH-MII, Multichannel intraluminal pH-impedance, SI, Symptom index, SSI, Symptom sensitivity index, SAP, Symptom association probability, PPI, Proton pump inhibitor

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 Dr Taher Omari is a member of the advisory board for Sandhill Scientific and received research funding by Sandhill Scientific. Sandhill Scientific had no role in the conception and preparation of this article.

PII: S0022-3476(08)00700-2

doi:10.1016/j.jpeds.2008.08.019

The Journal of Pediatrics
Volume 154, Issue 2 , Pages 248-252, February 2009