Esophageal Impedance in Children: Symptom-Based Results

• Published in: The Journal of pediatrics Vol. 157; no. 6; pp. 949 - 954.e2
• Main Authors: Salvatore, Silvia, Arrigo, Serena, Luini, Carlo, Vandenplas, Yvan
• Format: Journal Article
• Language: English
• Published: Maryland Heights, MO Mosby, Inc 01.12.2010; Elsevier
• Subjects: Biological and medical sciences; Electric Impedance; Esophageal pH Monitoring; Gastroesophageal Reflux - diagnosis; General aspects; Humans; Infant; Medical sciences; Pediatrics; Prospective Studies; AR; MII-pH; SAP; GER; SI; BEI; RI; AlkR; NAR; Gastroesophageal reflux; Reflux index; Bolus exposure index; Alkaline reflux; Multiple intraluminal esophageal impedance recording with pH-monitoring; Symptom association probability; Symptom index; Non-acid reflux; Acid reflux; Human; Pediatrics; Symptomatology; Digestive system; Impedance; Child; Esophagus; Result
• ISSN: 0022-3476; 1097-6833; 1097-6833
• DOI: 10.1016/j.jpeds.2010.07.029

To correlate multiple intraluminal esophageal impedance recording with pH-monitoring with symptoms. Symptoms occurring within a 2-minute window of a reflux were considered to be associated with reflux. Analyses were performed in 1- to 6-, 6- to 12-, and >12-months-old patients for crying, pain, cough, and vomiting. A total of 70 of 225 tracings were discarded. Of 2172 symptoms, 1136 (52%) were reflux-associated (45% acid reflux [AR], 51% weakly AR, 3% alkaline reflux). The strongest reflux-symptom association was found for vomiting. Cough-reflux association was higher in infants than in older children. In older patients, symptom-reflux association was more with AR. Symptoms were associated with proximal reflux in 70% of patients. The symptom index and symptom association probability (SAP) were positive (>50% for symptom index and >95% for SAP) for all refluxes in 83% and 46% of patients and for AR in 49% and 47% of patients, respectively. In 1- to 6-month-old infants, symptom index and SAP were higher for weakly AR than for AR. For crying, SAP was independent of AR or weakly AR. For cough, SAP was positive in one-third of patients, predominantly with AR in 6- to 12-month-old infants and with weakly AR in the other infants. Multiple intraluminal esophageal impedance recording with pH-monitoring doubles the probability of documenting an association between symptoms and reflux compared with pH monitoring. In young infants, symptoms are more frequently associated with weakly AR than with AR.