Elsevier

The Journal of Pediatrics

Volume 157, Issue 6, December 2010, Pages 949-954.e2
The Journal of Pediatrics

Original Article
Esophageal Impedance in Children: Symptom-Based Results

https://doi.org/10.1016/j.jpeds.2010.07.029Get rights and content

Objective

To correlate multiple intraluminal esophageal impedance recording with pH-monitoring with symptoms.

Study design

Symptoms occurring within a 2-minute window of a reflux were considered to be associated with reflux. Analyses were performed in 1- to 6-, 6- to 12-, and >12-months-old patients for crying, pain, cough, and vomiting.

Results

A total of 70 of 225 tracings were discarded. Of 2172 symptoms, 1136 (52%) were reflux-associated (45% acid reflux [AR], 51% weakly AR, 3% alkaline reflux). The strongest reflux-symptom association was found for vomiting. Cough-reflux association was higher in infants than in older children. In older patients, symptom-reflux association was more with AR. Symptoms were associated with proximal reflux in 70% of patients. The symptom index and symptom association probability (SAP) were positive (>50% for symptom index and >95% for SAP) for all refluxes in 83% and 46% of patients and for AR in 49% and 47% of patients, respectively. In 1- to 6-month-old infants, symptom index and SAP were higher for weakly AR than for AR. For crying, SAP was independent of AR or weakly AR. For cough, SAP was positive in one-third of patients, predominantly with AR in 6- to 12-month-old infants and with weakly AR in the other infants.

Conclusion

Multiple intraluminal esophageal impedance recording with pH-monitoring doubles the probability of documenting an association between symptoms and reflux compared with pH monitoring. In young infants, symptoms are more frequently associated with weakly AR than with AR.

Section snippets

Methods

Between March 2005 and July 2009, all children who were consecutively referred for an MII-pH investigation because of symptoms suspected to be GER-related were prospectively enrolled. Ethical board and parents approved analysis of data of the investigations that were performed on clinical indication. Patients with overt neurologic, allergic, or metabolic disease, cystic fibrosis, respiratory or gastrointestinal malformations, or acute infections were excluded. Acid suppression (proton pump

Results

Of the 225 subjects included, 70 MII-pH tracings were discarded because of absence of symptoms (n = 30) or artefacts or technical problems (n = 40). Whenever there was an artefact, the impedance was discarded to avoid erroneous evaluations of symptom-reflux associations, even when the tracing was acceptable for clinical interpretation (Figure; available at www.jpeds.com). At least one symptom was associated with a reflux episode in 126 patients (Table I; available at www.jpeds.com). In 29

Discussion

MII-pH is considered to be the most accurate method to detect and characterise GER episodes and provides additional clinical benefit to pH measurement alone.1, 15, 16, 17 In older data, weakly AR is at least as frequent as AR at all ages and more common in young infants, during the postprandial period or during treatment with proton pump inhibitors.2, 6, 7, 9, 18, 19, 20, 21, 22, 23 A clinical advantage of detecting all reflux episodes is to demonstrate a correlation between symptoms and reflux

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      This study shows the diagnostic usefulness of MII-pH in infants and children referred by GPs for suspected GORD, as well as its ability in directing therapy and avoiding unnecessary treatment. Previous reports had highlighted the greater sensitivity of MII-pH compared to pH-study only in detecting reflux events [19,20] and in identifying their association to symptoms [21,22], producing a change in managing the patients [23]. Conversely, MII-pH study did not provide a definite parameter profile correlating with the presence of oesophageal mucosa injury [24,25].

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    Y.P. served as a speaker for Abbott, AstraZeneca, Biogaia, and Mead Johnson Nutritionals and a consultant and speaker for Biocodex, Danone (Nutricia, SHS), Movetis, and Nestle Nutrition. The other authors declare no conflicts of interest.

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