Eur J Pediatr Surg 2014; 24(06): 514-518
DOI: 10.1055/s-0033-1354582
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Results of Multichannel Intraluminal Impedance pH Metry in Symptomathic Children with Normal pH Metry Findings

Tutku Soyer
1   Department of Pediatric Surgery, School of Medicine, Hacettepe University, Ankara, Turkey
,
Fulya Gulerman
2   Department of Pediatric Gastroenterology, Hepatology and Nutrition, Kırıkkale University School of Medicine, Kırıkkale, Turkey
,
Ozlem Boybeyi
3   Department of Pediatric Surgery, Kırıkkale University School of Medicine, Kırıkkale, Turkey
,
Mustafa Aslan
3   Department of Pediatric Surgery, Kırıkkale University School of Medicine, Kırıkkale, Turkey
,
Yasemin Gunal
3   Department of Pediatric Surgery, Kırıkkale University School of Medicine, Kırıkkale, Turkey
› Author Affiliations
Further Information

Publication History

26 March 2013

16 July 2013

Publication Date:
02 September 2013 (online)

Abstract

Aim A retrospective study was performed to evaluate the results of multichannel intraluminal impedance (MII) pH metry in symptomatic children with normal pH monitoring (PM) findings.

Patients and Methods Children who have reflux index (RI) less than 4% in PM and recurrent symptoms were included. All children underwent MII. Children who received antireflux treatment with normal PM findings were excluded from the study. MII results were evaluated for RI, content of reflux (acid, weak acid, and alkaline) number and type of impedance events, esophageal bolus clearance time and proximal extent of reflux (PER).

Results Eight patients (age range: 5–13 years) were included to the study. The male female ratio was 5:3. The recurrent symptoms were related with gastrointestinal (n = 5) and upper respiratory system (n = 3). One of the patients was operated for esophageal atresia and one was followed for corrosive esophageal disease. Four of the patients had RI higher than 4% in MII. Patients with normal RI in MII, had weak acid reflux (n: 1), alkaline reflux (n = 1) and no reflux (n = 2). When number of impedance events evaluated, four patients had abnormal reflux episodes (70 or more reflux episodes). Impedance event recordings were correlated in 75% of PM findings. The content of impedance events were mixed and gas in nature. Prolonged esophageal clearance time and PER were detected in patients with chest pain and operated esophageal atresia.

Conclusion MII can be considered as a superior diagnostic tool to detect weak acid and alkaline reflux in patients who had recurrent symptoms with normal PM studies. MII also provides information about bolus clearance time and extent of reflux.

 
  • References

  • 1 Pilic D, Fröhlich T, Nöh F , et al. Detection of gastroesophageal reflux in children using combined multichannel intraluminal impedance and pH measurement: data from the German Pediatric Impedance Group. J Pediatr 2011; 158 (4) 650-654 , e1
  • 2 López-Alonso M, Moya MJ, Cabo JA , et al. Twenty-four-hour esophageal impedance-pH monitoring in healthy preterm neonates: rate and characteristics of acid, weakly acidic, and weakly alkaline gastroesophageal reflux. Pediatrics 2006; 118 (2) e299-e308
  • 3 Silny J. Intraluminal multiple electric impedance procedure for measurement of gastrointestinal motility. J Gastrointest Motil 1991; 3: 151-162
  • 4 Wenzl TG. Evaluation of gastroesophageal reflux events in children using multichannel intraluminal electrical impedance. Am J Med 2003; 115 (Suppl 3A): 161S-165S
  • 5 Shay S, Tutuian R, Sifrim D , et al. Twenty-four hour ambulatory simultaneous impedance and pH monitoring: a multicenter report of normal values from 60 healthy volunteers. Am J Gastroenterol 2004; 99 (6) 1037-1043
  • 6 Working Group of the European Society of Pediatric Gastroenterology and Nutrition. A standardized protocol for the methodology of esophageal pH monitoring and interpretation of the data for the diagnosis of gastroesophageal reflux. J Pediatr Gastroenterol Nutr 1992; 14 (4) 467-471
  • 7 Di Pace MR, Caruso AM, Catalano P, Casuccio A, De Grazia E. Evaluation of esophageal motility using multichannel intraluminal impedance in healthy children and children with gastroesophageal reflux. J Pediatr Gastroenterol Nutr 2011; 52 (1) 26-30
  • 8 Zerbib F, des Varannes SB, Roman S , et al. Normal values and day-to-day variability of 24-h ambulatory oesophageal impedance-pH monitoring in a Belgian-French cohort of healthy subjects. Aliment Pharmacol Ther 2005; 22 (10) 1011-1021
  • 9 Shay S, Richter J. Direct comparison of impedance, manometry, and pH Probe in detecting reflux before and after a meal. Dig Dis Sci 2005; 50 (9) 1584-1590
  • 10 Castell DO, Vela M. Combined multichannel intraluminal impedance and pH-metry: an evolving technique to measure type and proximal extent of gastroesophageal reflux. Am J Med 2001; 111 (Suppl 8A): 157S-159S
  • 11 Wise JL, Murray JA. Utilising multichannel intraluminal impedance for diagnosing GERD: a review. Dis Esophagus 2007; 20 (2) 83-88