Search

Background and aim: PH-monitoring is the most widely accepted tool for the diagnosing of gastroesophageal reflux (GER); however it does not detect non acid refluxes. MII is a new method for pH-indipendent detection of GER however, few data are available in childhood. Our aim was to compare the 24hr pH-study versus the combined 24-hrs pH and MII monitoring for the assessment of GER and related symptoms in children.Methods: Fourteen children [M 7; mean age: 1,2 y (range 0,42 y - 10,4 y)] with symptoms suggestive of GER, underwent 24hr pH-study/MII recording. Reflux episodes revealed by 24hr pH-study were analysed at the light of the retrograde bolus movements detected by MII. The symptom index (SI) and the symptom sensitivity index (SSI) were calculated for both the techniques and according with the type of symptoms (typical or atypical).Results: In the 14 children studied, the MII detected 1145 episodes of reflux of which 660 (58%) were associated with decreases in pH less than 4.0. The analysis of the 24hr pH-study blinded to the impedance data revealed a total of 1232 reflux episodes; of these only 660 were also associated with retrograde bolus movement detected by MII (SS and PPV of 24hr pH-study compared to MII: 54% and 58%). A total of 109 symptoms were reported: 58 typical and 51 atypical. The SI and SSI were significantly higher for the MII as compared to 24hr pH-study [(total symptoms: 58% and 5,5% vs. 28% and 2,5%; p<0,00002 and p<0,0004 respectively), (typical symptoms: 62% and 3,1% vs. 40% and 1,8%; p<0,01 and p<0,05 respectively) and (atypical symptoms: 53% and 2,4% vs. 18% and 0,7%; p<0,0004 and p<0,002 respectively).Summary and conclusions: More than 40% of reflux episodes detected by pH-monitoring are not associated with retrograde bolus movement (false positive) and are responsible for the low PPV of the 24hr pH-study. SI and SII are significantly higher if assessed by MII especially for atypical symptoms, demonstrating the superiority of MII for the study of atypical manifestation of GER.

The relationship between GER and AOP in newborns is still controversial. The aim of our study was to assess if MII-pH study could be useful to detect the association between GER and AOP in a subgroup of preterms selected for the absence of confounding factors. Were included newborns who satisfied the following criteria: postnatal age less than 30 days, no response to conventional treatment of AOP, no ventilatory support, full enteral feeding (intermittent suckling bolus) and absence of known causes of AOP. Five newborns [3 M; median ga 32 weeks (range 29–36); bw 1740 gr (range 1300–2350); age at study 15 days (range 8–21)] underwent simultaneous 24hours recording of MII-pH, continuous pulse oximeter saturation and ECG. A reflux event (RE) was defined by MII when a fall in impedance <50% from baseline occurred in at least the two distal channels in an aboral direction. A temporal association between RE and apnea and/or bradycardia was considered present if these events commenced within 20 seconds the onset of a RE. In the recording period a total of 285 RE [median rate of 55 per recording (range: 41–71)] and 115 apnoea [median rate of 24 per recording (range: 3–35)] were detected. Thirty-six AOP were associated with RE (31%). Frequency of events during RE was significantly greater than in reflux-free period [0.48/min (0 - 1.28) vs. 0.013/min (0.003 - 0.05); p<0.05]. Out of 36 RE-associated apnea, 31 were not acid (86%). Frequency of events during non-acid RE was greater than in reflux-free period [0.38/min (0 - 1.3) vs. 0.004/min (0.02 - 0.036); p<0.05]. No difference was found in the frequency of events associated and not associated with acid-RE.Our data show that both AOP and GER were common in these infants and seem to be temporally related.