24-hour esophageal pH monitoring in children with pathological acid gastroesophageal reflux: primary and secondary to food allergy. Part II. Intraesophageal pH values in proximal channel; preliminary study and control studies--after 1, 2, 4 and 9 years of clinical observation as well as dietary and pharmacological treatment

Abstract

Purpose: Among 264 children suspected of GERD, acid GER was confirmed in 138 children on the basis of 24-hour pH monitoring.

Aims of the study: Comparative analysis of parameters of 24-hour intraesophageal pH monitoring with dual-channel probe (in proximal channel) in children with acid GER: primary and secondary to cow milk allergy and/or other food allergy (CMA/FA) diagnosed; comparison of examined values of pH monitoring parameters with regard to duration of the disease (preliminary study and prospective studies--after 1, 2, 4 and 9 years of clinical observation and/or conservative treatment).

Material and methods: 264 children suspected of GERD, aged: 1.5-102 months; x = 20.78 +/- 17.23 months, were enrolled in a study. In order to differentiate acid primary GER from GER secondary to CMA/FA in 138 (52.3%) children with GERD immunoallergological tests were performed. Positive result of oral food challenge test confirmed the allergy being the cause of GER. 138 children with pathological acid GER were qualified into two groups: 1 and 2. Group 1--76 patients (55.1%), aged: 4-102 months; x = 25.2 +/- 27.28 months, with pathological primary GER. Group 2--62 patients (44.9%), aged: 4-74 months; x = 21.53 +/- 17.79 months, with pathological GER secondary to CMA/FA.

Results: Significant differentiation of the mean values of these parameters between preliminary study and control studies within groups was shown in the case of: number of episodes of acid GER and duration of the longest episode of acid GER, acid GER index: total and supine (proximal channel). Statistical significance (p < 0.05) was higher in group 1, especially during prospective clinical observation and/or conservative treatment. At the same time significant differentiation of the mean values of: number of episodes of acid GER and episodes of acid GER lasting more than 5 minutes and mean values of acid GER index: total and supine was shown between the groups. Statistical significance (p < 0.05) was higher in group 2.

Conclusions: The preliminary study of examined children confirmed that values of pH monitoring in proximal channel were comparable to those in distal channel and did not contribute to differentiation of GER into primary and secondary. During prospective clinical observation and/or clinical treatment, on the basis of consecutive measurements, especially the number of episodes of acid GER and episodes of acid GER lasting more than 5 minutes, and also supine acid GER index it was stated that GER secondary to CMA/FA was of wider extent (higher) in comparison with primary GER in these patients.