24-hour esophageal pH-monitoring in children suspected of gastroesophageal reflux disease: analysis of intraesophageal pH monitoring values recorded in distal and proximal channel at diagnosis

Abstract

Aim: To assess values of 24-h esophageal pH-monitoring parameters with dual-channel probe (distal and proximal channel) in children suspected of gastroesophageal reflux disease (GERD).

Methods: 264 children suspected of gastroesophageal reflux (GER) were enrolled in a study (mean age c=20.78+/-17.23 mo). The outcomes of this study, immunoallerrgological tests and positive result of oral food challenge test with a potentially noxious nutrient, enabled to qualify children into particular study groups.

Results: 32 (12.1%) infants (group 1) had physiological GER diagnosed. Pathological acid GER was confirmed in 138 (52.3%) children. Primary GER was diagnosed in 76 (28.8%) children (group 2) and GER secondary to allergy to cow milk protein and/or other food (CMA/FA) in 62 (23.5%) children (group 3). 32 (12.1%) of them had CMA/FA (group 4-reference group), and in remaining 62 (23.5%) children neither GER nor CMA/FA was confirmed (group 5). Mean values of pH monitoring parameters measured in distal and proximal channel were analyzed in individual groups. This analysis showed statistically significant differentiation of mean values in the case of: number of episodes of acid GER, episodes of acid GER lasting >5 min, duration of the longest episode of acid GER in both channels, acid GER index total and supine in proximal channel. Statistically significant differences of mean values among examined groups, especially between group 2 and 3 in the case of total acid GER index (only distal channel) were confirmed.

Conclusion: 24-h esophageal pH monitoring confirmed pathological acid GER in 52.3% of children with typical and atypical symptoms of GERD. The similar pH-monitoring values obtained in group 2 and 3 confirm the necessity of implementation of differential diagnosis for primary vs secondary cause of GER.

Figure 1

Summary analysis of number of episodes of acid GER (pH < 4) and episodes of acid GER (pH < 4) lasting > 5 min of 24-h pH-monitoring in 264 children suspected of GERD; pH-monitoring with 1¹- or 2-channel probe. ¹Values of pH-monitoring parameters in group 1 did not undergo comparative analysis with corresponding values in remaining groups.

Figure 2

Summary analysis of number of episodes of acid GER (pH < 4) and episodes of acid GER (pH < 4) lasting > 5 min of 24-h pH-monitoring in 232 children suspected of GERD; pH-monitoring with 2- channel probe.

Figure 3

Summary analysis of duration of the longest episode of acid GER of 24-h pH-monitoring in 264 children suspected of GERD; pH-monitoring with 1¹- or 2- channel probe. ¹Values of pH-monitoring parameters in group 1 did not undergo comparative analysis with corresponding values in remaining groups.

Figure 4

Summary analysis of duration of the longest episode of acid GER of 24-h pH-monitoring in 232 children suspected of GERD; pH-monitoring with 2- channel probe.

Figure 5

Summary analysis of total acid GER index and acid GER index (supine position) of 24-h pH-monitoring in 264 children suspected of GERD; pH-monitoring with 1¹- or 2-channel probe. ¹Values of pH-monitoring parameters in group 1 did not undergo comparative analysis with corresponding values in remaining groups.

Figure 6

Summary analysis of total acid GER index and acid GER index (supine position) of 24-h pH-monitoring in 232 children suspected of GERD; pH-monitoring with 2- channel probe.