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Volume 154, Issue 2, Pages 248-252 (February 2009)


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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, MsCaCorresponding Author Informationemail address, Marc A. Benninga, MD, PhDa, Geoffrey P. Davidson, MBBS, MD, FRACPbc, Taher I. Omari, PhDbc

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.

a Academic Medical Centre, Amsterdam, The Netherlands

b Women's and Children's Hospital, Adelaide, Australia

c Department of Paediatrics, University of Adelaide, Adelaide, Australia

Corresponding Author InformationReprint requests: Clara Maria Loots, Motility Center, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

 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


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