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. 2009 Aug;49(2):177-82.
doi: 10.1097/MPG.0b013e318195d7b3.

Technical limitations in detection of gastroesophageal reflux in neonates

Juliann M Di Fiore  1 , Marina Arko, Kim Churbock, Anna Maria Hibbs, Richard J Martin
Affiliations

Technical limitations in detection of gastroesophageal reflux in neonates

Juliann M Di Fiore et al. J Pediatr Gastroenterol Nutr. 2009 Aug.

Erratum in

  • J Pediatr Gastroenterol Nutr. 2009 Sep;49(3):378

Abstract

Objective: Characterize the incidence and possible etiologies of acid reflux events detected by pH and not identified by multiple intraluminal impedance (MII) monitoring.

Materials and methods: Acid reflux events detected by pH but not identified by MII (pH-only) were documented in 80 preterm and 39 term infants. Reasons for failure of MII to detect these events were classified as failure to meet MII scoring criteria, presence of an air bolus, technical artifact, and no change in impedance. Events with no change in impedance were stratified to low impedance throughout the study (possible esophageal inflammation), transient decrease in pre-event impedance (presence of refluxate), occurrence <30 seconds of a preceding event, and no explanation.

Results: A total of 2572 events were detected by pH, with 59% of events not identified by MII. A higher incidence of pH-only events occurred in preterm versus term infants (54 +/- 27% versus 42 +/- 23%, P = .025, respectively). Thirteen percent of pH-only events were missed due to MII scoring criteria, 12% due to technical artifact, 11% due to an air bolus, and 64% had no change in impedance. Of the 978 events with no change in impedance, 154 were associated with low impedance throughout the study, 430 with a transient decrease in pre-event impedance, and 175 were preceded by a reflux episode within 30 seconds.

Conclusions: There was a high incidence of acid reflux events detected by pH but not identified by MII. This occurred more often in the least mature infants, and we speculate that delayed esophageal fluid clearance is the major underlying mechanism.

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Figures

Figure 1
Figure 1
Events detected by pH and not identified by MII were stratified by the possible reason for discrepancy between the two modes of gastroesophageal reflux detection.
Figure 2
Figure 2
Events detected by pH were not identified by MII due to not meeting scoring criteria on MII (13%), technical artifact (12%), and the presence of a positive impedance deflection or air bolus (11%). The remaining 64% of acid reflux events detected by pH but not impedance had no indication of any change in impedance.
Figure 3
Figure 3
pH-only events accompanied by no change in impedance were associated with 1) a mean overall study impedance of <1000 ohms in 16% of events indicating possible esophageal inflammation, 2) a baseline impedance of <1300 Ω in 44% of events indicating the possible presence of fluid already in the esophagus before the pH-only event and 3) a reflux event preceding the pH-only event in 18% of events indicating incomplete reflux clearance. The remaining 22% of pH-only events had no explanation.
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References

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