DOI QR코드

DOI QR Code

Esophageal pH and Combined Impedance-pH Monitoring in Children

  • Shin, Myung Seok (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
  • Received : 2014.02.05
  • Accepted : 2014.02.19
  • Published : 2014.03.30

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

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. https://doi.org/10.1097/01.mpg.0000361306.15727.54
  2. 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;104:1278-95; quiz 1296. https://doi.org/10.1038/ajg.2009.129
  3. Spencer J. Prolonged pH recording in the study of gastro-oesophageal reflux. Br J Surg 1969;56:912-4. https://doi.org/10.1002/bjs.1800561211
  4. 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):S1-31.
  5. Silny J. Intraluminal multiple electric impedance procedure for measurement of gastrointestinal motility. Neurogastroenterol Motil 1991;3:151-62.
  6. Lee SH, Jang JY, Yoon IJ, Kim KM. Usefulness of multichannel intraluminal impedance-pH metry in children with suspected gastroesophageal reflux disease. Korean J Gastroenterol 2008;52:9-15.
  7. Shin MS, Shim JO, Moon JS, Kim HS, Ko JS, Choi JH, et al. Impedance-pH monitoring and conventional pH monitoring are complementary methods to detect association between gastroesophageal reflux and apnea-related symptoms in preterm infants and neonates. J Matern Fetal Neonatal Med 2012;25:2406-10. https://doi.org/10.3109/14767058.2012.697944
  8. Wenzl TG, Benninga MA, Loots CM, Salvatore S, Vandenplas Y; ESPGHAN EURO-PIG Working Group. Indications, methodology, and interpretation of combined esophageal impedance-pH monitoring in children: ESPGHAN EURO-PIG standard protocol. J Pediatr Gastroenterol Nutr 2012;55:230-4. https://doi.org/10.1097/MPG.0b013e3182592b65
  9. 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;14:467-71. https://doi.org/10.1097/00005176-199205000-00017
  10. Vandenplas Y. Challenges in the diagnosis of gastroesophageal reflux disease in infants and children. Expert Opin Med Diagn 2013;7:289-98. https://doi.org/10.1517/17530059.2013.789857
  11. Tutuian R, Castell DO. Review article: complete gastro-oesophageal reflux monitoring combined pH and impedance. Aliment Pharmacol Ther 2006;24(Suppl 2):27-37. https://doi.org/10.1111/j.1365-2036.2006.03039.x
  12. van Wijk MP, Benninga MA, Omari TI. Role of the multichannel intraluminal impedance technique in infants and children. J Pediatr Gastroenterol Nutr 2009;48:2-12. https://doi.org/10.1097/MPG.0b013e31818f0902
  13. Wenzl TG, Schenke S, Peschgens T, Silny J, Heimann G, Skopnik H. Association of apnea and nonacid gastroesophageal reflux in infants: Investigations with the intraluminal impedance technique. Pediatr Pulmonol 2001;31:144-9. https://doi.org/10.1002/1099-0496(200102)31:2<144::AID-PPUL1023>3.0.CO;2-Z
  14. Rosen R, Nurko S. The importance of multichannel intraluminal impedance in the evaluation of children with persistent respiratory symptoms. Am J Gastroenterol 2004;99:2452-8. https://doi.org/10.1111/j.1572-0241.2004.40268.x
  15. Mousa H, Woodley FW, Metheney M, Hayes J. Testing the association between gastroesophageal reflux and apnea in infants. J Pediatr Gastroenterol Nutr 2005;41:169-77. https://doi.org/10.1097/01.mpg.0000173603.77388.84
  16. Magista AM, Indrio F, Baldassarre M, Bucci N, Menolascina A, Mautone A, et al. Multichannel intraluminal impedance to detect relationship between gastroesophageal reflux and apnoea of prematurity. Dig Liver Dis 2007;39:216-21. https://doi.org/10.1016/j.dld.2006.12.015
  17. Loots CM, Benninga MA, Davidson GP, Omari TI. Addition of pH-impedance monitoring to standard pH monitoring increases the yield of symptom association analysis in infants and children with gastroesophageal reflux. J Pediatr 2009;154:248-52. https://doi.org/10.1016/j.jpeds.2008.08.019
  18. Colletti RB, Christie DL, Orenstein SR. Statement of the North American Society for Pediatric Gastroenterology and Nutrition (NASPGN). Indications for pediatric esophageal pH monitoring. J Pediatr Gastroenterol Nutr 1995;21:253-62. https://doi.org/10.1097/00005176-199510000-00002
  19. Peter CS, Wiechers C, Bohnhorst B, Silny J, Poets CF. Influence of nasogastric tubes on gastroesophageal reflux in preterm infants: a multiple intraluminal impedance study. J Pediatr 2002;141:277-9. https://doi.org/10.1067/mpd.2002.126298
  20. Strobel CT, Byrne WJ, Ament ME, Euler AR. Correlation of esophageal lengths in children with height: application to the Tuttle test without prior esophageal manometry. J Pediatr 1979;94:81-4. https://doi.org/10.1016/S0022-3476(79)80361-3
  21. Mousa HM, Rosen R, Woodley FW, Orsi M, Armas D, Faure C, et al. Esophageal impedance monitoring for gastroesophageal reflux. J Pediatr Gastroenterol Nutr 2011;52:129-39. https://doi.org/10.1097/MPG.0b013e3181ffde67
  22. Mainie I, Tutuian R, Shay S, Vela M, Zhang X, Sifrim D, et al. Acid and non-acid reflux in patients with persistent symptoms despite acid suppressive therapy: a multicentre study using combined ambulatory impedance-pH monitoring. Gut 2006;55:1398-402. https://doi.org/10.1136/gut.2005.087668
  23. Loots CM, van Wijk MP, Blondeau K, Dalby K, Peeters L, Rosen R, et al. Interobserver and intraobserver variability in pH-impedance analysis between 10 experts and automated analysis. J Pediatr 2012;160:441-6. https://doi.org/10.1016/j.jpeds.2011.08.017
  24. Lopez-Alonso M, Moya MJ, Cabo JA, Ribas J, del Carmen Macias M, Silny J, 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:e299-308. https://doi.org/10.1542/peds.2005-3140
  25. Shay S, Tutuian R, Sifrim D, Vela M, Wise J, Balaji N, 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;99:1037-43. https://doi.org/10.1111/j.1572-0241.2004.04172.x
  26. Zerbib F, des Varannes SB, Roman S, Pouderoux P, Artigue F, Chaput U, et al. Normal values and day-to-day variability of 24-h ambulatory oesophageal impedancepH monitoring in a Belgian-French cohort of healthy subjects. Aliment Pharmacol Ther 2005;22:1011-21. https://doi.org/10.1111/j.1365-2036.2005.02677.x
  27. Breumelhof R, Smout AJ. The symptom sensitivity index: a valuable additional parameter in 24-hour esophageal pH recording. Am J Gastroenterol 1991;86:160-4.
  28. Weusten BL, Roelofs JM, Akkermans LM, Van Berge-Henegouwen GP, Smout AJ. The symptom-association probability: an improved method for symptom analysis of 24-hour esophageal pH data. Gastroenterology 1994;107:1741-5. https://doi.org/10.1016/0016-5085(94)90815-X
  29. Rosen R, Lord C, Nurko S. The sensitivity of multichannel intraluminal impedance and the pH probe in the evaluation of gastroesophageal reflux in children. Clin Gastroenterol Hepatol 2006;4:167-72. https://doi.org/10.1016/S1542-3565(05)00854-2
  30. Woodley FW, Mousa H. Acid gastroesophageal reflux reports in infants: a comparison of esophageal pH monitoring and multichannel intraluminal impedance measurements. Dig Dis Sci 2006;51:1910-6. https://doi.org/10.1007/s10620-006-9179-0
  31. Skopnik H, Silny J, Heiber O, Schulz J, Rau G, Heimann G. Gastroesophageal reflux in infants: evaluation of a new intraluminal impedance technique. J Pediatr Gastroenterol Nutr 1996;23:591-8. https://doi.org/10.1097/00005176-199612000-00014
  32. Condino AA, Sondheimer J, Pan Z, Gralla J, Perry D, O'Connor JA. Evaluation of infantile acid and nonacid gastroesophageal reflux using combined pH monitoring and impedance measurement. J Pediatr Gastroenterol Nutr 2006;42:16-21. https://doi.org/10.1097/01.mpg.0000188008.66752.72
  33. Peter CS, Wiechers C, Bohnhorst B, Silny J, Poets CF. Detection of small bolus volumes using multiple intraluminal impedance in preterm infants. J Pediatr Gastroenterol Nutr 2003;36:381-4. https://doi.org/10.1097/00005176-200303000-00016
  34. Wise JL, Murray JA. Utilising multichannel intraluminal impedance for diagnosing GERD: a review. Dis Esophagus 2007;20:83-8. https://doi.org/10.1111/j.1442-2050.2007.00654.x
  35. Di Fiore JM, Arko M, Churbock K, Hibbs AM, Martin RJ. Technical limitations in detection of gastroesophageal reflux in neonates. J Pediatr Gastroenterol Nutr 2009;49:177-82. https://doi.org/10.1097/MPG.0b013e318195d7b3
  36. Woodley FW, Mousa H. "pH-Only" acid reflux events in infants during later phases of the feeding cycle are less acidic and cleared more efficiently than classic 2-phase acid reflux events. J Pediatr Gastroenterol Nutr 2009;48:41-7. https://doi.org/10.1097/MPG.0b013e31816f214a
  37. Vandenplas Y, Salvatore S, Vieira MC, Hauser B. Will esophageal impedance replace pH monitoring? Pediatrics 2007;119:118-22. https://doi.org/10.1542/peds.2006-1753
  38. Corvaglia L, Mariani E, Aceti A, Capretti MG, Ancora G, Faldella G. Combined oesophageal impedance-pH monitoring in preterm newborn: comparison of two options for layout analysis. Neurogastroenterol Motil 2009;21:1027-e81. https://doi.org/10.1111/j.1365-2982.2009.01301.x

Cited by

  1. Wireless esophageal pH capsule for patients with gastroesophageal reflux disease: A multicenter clinical study vol.20, pp.40, 2014, https://doi.org/10.3748/wjg.v20.i40.14865
  2. Temporal Association Between Reflux-like Behaviors and Gastroesophageal Reflux in Preterm and Term Infants vol.62, pp.4, 2014, https://doi.org/10.1097/mpg.0000000000000968
  3. Correlation between the different pH-metry scores in gastroesophageal reflux disease in children vol.95, pp.26, 2016, https://doi.org/10.1097/md.0000000000003804
  4. How to Care for Patients with EA-TEF: The Known and the Unknown vol.19, pp.12, 2014, https://doi.org/10.1007/s11894-017-0605-6
  5. Robin sequence: what the multidisciplinary approach can do vol.10, pp.None, 2017, https://doi.org/10.2147/jmdh.s98967
  6. Impedance Testing in Esophageal Atresia Patients vol.5, pp.None, 2017, https://doi.org/10.3389/fped.2017.00085
  7. The significance of different methods for detection of gastroesophageal reflux in children vol.69, pp.1, 2014, https://doi.org/10.5937/mp69-16224
  8. Correlation between esophageal pH-metry and esophagitis in gastroesophageal reflux disease in children vol.97, pp.37, 2014, https://doi.org/10.1097/md.0000000000012042
  9. Advances in the Diagnosis of GERD Using the Esophageal pH Monitoring, Gastro-Esophageal Impedance-pH Monitoring, And Pitfalls vol.6, pp.10, 2014, https://doi.org/10.3889/oamjms.2018.410
  10. Optimizing the Use of Medications and Other Therapies in Infant Gastroesophageal Reflux vol.20, pp.6, 2018, https://doi.org/10.1007/s40272-018-0311-3
  11. Gastroesophageal Reflux Events Occurring During a Meal Can Still Be Temporally Associated With a Symptom Even When Analysis Settings Are Set to Exclude Meals vol.25, pp.3, 2014, https://doi.org/10.5056/jnm19020
  12. Age and Upper Airway Obstruction: A Challenge to the Clinical Approach in Pediatric Patients vol.17, pp.10, 2020, https://doi.org/10.3390/ijerph17103531
  13. The influence of Intrapulmonary percussive ventilation on gastroesophageal reflux in infants under the age of 1 year vol.55, pp.11, 2014, https://doi.org/10.1002/ppul.25045
  14. Usefulness of Endoscopic Hill Grade in Evaluating Children Suspected of Having Gastroesophageal Reflux Disease vol.27, pp.2, 2014, https://doi.org/10.5056/jnm20033