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Review
. 2014 Mar;17(1):13-22.
doi: 10.5223/pghn.2014.17.1.13. Epub 2014 Mar 31.

Esophageal pH and Combined Impedance-pH Monitoring in Children

Myung Seok Shin  1
Affiliations
Review

Esophageal pH and Combined Impedance-pH Monitoring in Children

Myung Seok Shin. Pediatr Gastroenterol Hepatol Nutr. 2014 Mar.

Abstract

Esophageal pH monitoring is considered the gold standard for the diagnosis of gastroesophageal reflux disease because of the normal ranges across the pediatric age range. However, this method can only detect acid reflux. Multichannel intraluminal impedance-pH (MII-pH) monitoring has recently been used for the detection of bolus reflux in infants and children. This method allows for the detection of liquid, gas or mixed reflux in addition to acid, weakly acidic or weakly alkaline reflux. MII-pH monitoring can record the direction of flow and the height of reflux, which are useful parameters to identify an association between symptoms and reflux. However, the technique is limited by its high cost and the lack of normative data of MII-pH in the pediatric population. Despite certain limitations, MII-pH monitoring will become more common and gradually replace pH monitoring in the future, because pH monitoring is part of MII-pH.

Keywords: Child; Esophageal pH monitoring; Gastroesophageal reflux; Impedance-pH monitoring; Infant.

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Figures

Fig. 1
Fig. 1
Pediatric type probe and bolus acid reflux in multichannel intraluminal impedance-pH (MII-pH) monitoring. A combined MII-pH probe has 6 impedance channels and a pH sensor. The impedance electrodes are 2 cm apart from each other and the pH sensor is in the middle of the most distal impedance channel. The pH sensor is placed 3 cm above the lower esophageal sphincter (LES). The probe with the internal reference electrode crosses the LES. As the bolus reaches the impedance channel, impedance decreases rapidly. Bolus entry occurs at the 50% drop in impedance from baseline and bolus exit occurs above the 50% threshold value. Bolus reflux is defined as an impedance drop in at least 2 distal channels. Bolus clearance time is the time from bolus entry to exit. The retrograde bolus reflux is shown as bolus entry progression from distal to proximal impedance channels (dashed arrows) followed by proximal to distal bolus exit progression. Bolus reflux episodes during which the pH drops from above to below 4 are considered acid. Acid clearance time is the tie of esophageal exposure to a pH<4.
See this image and copyright information in PMC

References

    1. Vandenplas Y, Rudolph CD, Di Lorenzo C, Hassall E, Liptak G, Mazur L, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) J Pediatr Gastroenterol Nutr. 2009;49:498–547. - PubMed
    1. Sherman PM, Hassall E, Fagundes-Neto U, Gold BD, Kato S, Koletzko S, et al. A global, evidence-based consensus on the definition of gastroesophageal reflux disease in the pediatric population. Am J Gastroenterol. 2009;104:1278–1295. quiz 1296. - PubMed
    1. Spencer J. Prolonged pH recording in the study of gastro-oesophageal reflux. Br J Surg. 1969;56:912–914. - PubMed
    1. Rudolph CD, Mazur LJ, Liptak GS, Baker RD, Boyle JT, Colletti RB, et al. North American Society for Pediatric Gastroenterology and Nutrition. Guidelines for evaluation and treatment of gastroesophageal reflux in infants and children: recommendations of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr. 2001;32(Suppl 2):S1–S31. - PubMed
    1. Silny J. Intraluminal multiple electric impedance procedure for measurement of gastrointestinal motility. Neurogastroenterol Motil. 1991;3:151–162.