Multichannel Intraluminal Impedance and pH Monitoring: A Step Towards Pediatric Reference Values

Abstract

Background/aims: Combined multichannel intraluminal impedance and pH monitoring (MII/pH) is considered the most accurate test to detect gastroesophageal reflux (GER), however lacking reference values. We aim to determine reference values for the pediatric population and to correlate these values with age and postprandial/fasting period.

Methods: We evaluated MII/pH traces from patients (newborns, infants, and children) admitted to 3 Italian hospitals and who underwent MII/ pH for suspected GER disease. Patients with MII/pH traces that showed significant symptom-reflux associations and/or a pathological reflux index (> 6% for newborns and infants, > 3% for children) were excluded. Traces were analysed in their entirety, and in the postprandial period (first hour after a meal) and the fasting period (the following hours before the next meal) separately.

Results: A total of 195 patients (46 newborns, 83 infants, and 66 children) were included. Age positively correlated with frequency of acidic GER events (r = 0.37, P < 0.05) and negatively associated with weakly acidic GER events (r = 0.46, P < 0.05).

Conclusions: This study describes the distribution of MII/pH values in a pediatric population with normally acidic GER exposure and no significant association between GER events and symptoms. These MII/pH values may be used as reference values in clinical practice for a corrected GER disease diagnosis in the pediatric population.

Keywords: Child; Esophageal pH monitoring; Gastroesophageal reflux; Infant; Reference values.

Figure 1

Differences in multichannel intraluminal impedance acidic gastroesophageal reflux (MII-A-GER) frequency (A) and multichannel intraluminal impedance weakly acidic gastroesophageal reflux (MII-WA-GER) frequency (B) between postprandial and fasting periods in newborns, infants, and children. *P < 0.05.

Figure 2

Relationship between fasting multichannel intraluminal impedance acidic gastroesophageal reflux (MII-A-GER) events and postprandial multichannel intraluminal impedance weakly acidic gastroesophageal reflux (MII-WA-GER) events.