The Correlation between Endoscopic Reflux Esophagitis and Combined Multichannel Intraluminal Impedance-pH Monitoring in Children

Yu-Wen Liu; Jia-Feng Wu; Huey-Ling Chen; Hong-Yuan Hsu; Mei-Hwei Chang; Wei-Chung Hsu; Ping-Huei Tseng; Hsiu-Po Wang; Yen-Hsuan Ni

doi:10.1016/j.pedneo.2015.09.008

The Correlation between Endoscopic Reflux Esophagitis and Combined Multichannel Intraluminal Impedance-pH Monitoring in Children

Pediatr Neonatol. 2016 Oct;57(5):385-389. doi: 10.1016/j.pedneo.2015.09.008. Epub 2015 Dec 23.

Authors

Yu-Wen Liu¹, Jia-Feng Wu¹, Huey-Ling Chen¹, Hong-Yuan Hsu¹, Mei-Hwei Chang¹, Wei-Chung Hsu², Ping-Huei Tseng³, Hsiu-Po Wang³, Yen-Hsuan Ni⁴

Affiliations

¹ Department of Pediatrics, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
² Department of Otolaryngology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
³ Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
⁴ Department of Pediatrics, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan. Electronic address: yhni@ntu.edu.tw.

PMID: 26803582
DOI: 10.1016/j.pedneo.2015.09.008

Abstract

Background: Gastroesophageal reflux (GER) is the retrograde flow of gastric contents into the esophagus and may induce a variety of complications. Endoscopically visible breaks in the distal esophageal mucosa are the most reliable evidence of reflux esophagitis. Combined multichannel intraluminal impedance and pH-metry (MII-pH) is a technique that enables monitoring of GER independent of its acidity. The aim of this study is to investigate the GER patterns in children with the aid of MII-pH monitoring and determine the correlation between endoscopically proven reflux esophagitis and reflux types by MII-pH monitoring.

Methods: One hundred and twenty children were enrolled from January 2010 to October 2011 for MII-pH monitoring. We studied the GER patterns by means of pH (acid and nonacid reflux) and composition (liquid, mixed, and gas reflux) by the esophageal MII-pH signals. Meanwhile, 34 (28.3%) patients received esophagogastroduodenoscopy examination at the same time. The severity of reflux esophagitis was graded with Los Angeles classification.

Results: MII-pH monitoring significantly increased the detection of numbers of reflux compared with traditional 24-hour pH monitoring (p < 0.001). The significant cutoff value of MII-pH parameters including DeMeester score ≥ 21, duration of longest acid reflux ≥ 17 minutes, and occurrence of acid reflux for more than 5 minutes showed good correlation in the prediction of the presence of endoscopic reflux esophagitis. The odds ratios of the above mentioned parameters were 12.6, 8.94, and 7.5, respectively (p = 0.02, p = 0.01, and p = 0.01). Furthermore, ≥ 3 episodes per day of acid reflux for more than 5 minutes can predict the occurrence of severe reflux esophagitis (odds ratio 12.78, p = 0.009).

Conclusion: MII-pH monitoring not only raised the diagnostic yield in identifying GER, but it also showed significant correlation with the presence of endoscopically proven reflux esophagitis in children.

Keywords: esophageal impedance; gastroesophageal reflux; reflux esophagitis.

MeSH terms

Adolescent
Child
Child, Preschool
Cohort Studies
Electric Impedance
Endoscopy*
Esophageal pH Monitoring*
Esophagitis, Peptic / diagnosis*
Female
Gastroesophageal Reflux / diagnosis*
Humans
Infant
Infant, Newborn
Male
Predictive Value of Tests