胃食管双PH监测小儿十二脂肠胃食管返流

采用胃、食管双ＰＨ电极对２１例１～１２个月个月小儿进行２４ｈｐＨ值监测。７例无返流小儿为对照组，１４例有返流的小儿中９例为酸性返流（６４％），５例（３６％）为碱性返流即十二指肠胃食管返流（其中４例合并酸性返流）。碱性返流可引起严重的食管病变。传统的单一食管下端ＰＨ监测难以作出准确诊断，增加胃底ＰＨ监测为准确羊定返流，特别是十二脂肠胃食管返流提供重要根据，对于提高胃食管返流诊断率和指导临床对不同类型     

小儿十二指肠胃返流与碱性胃食管返流的pH动态变化特点

动脉监测儿小十二指肠胃返流与碱性胃食管返流的ｐＨ变化特点，研究返流发生的病理生理意义。方法：对６８例病理性胃食管返流小儿及３９例正常小儿进行胃食管双ｐＨ２４小时动态监测，观察小儿在进餐及胃排空后以及不同体拉下胃食管ｐＨ值的变化的特点。结果：对照组中１９例监测到十二指肠胃返流，以立位及进餐后发生为主，持续时间短暂。     

小儿哮喘与胃食管返流的研究

为探讨小儿哮喘与胃食管返流（ＧＥＲ）的关系，采用便携式ｐＨ自动记录仪对４１例反复发作的哮喘患儿进行了２４小时食管ｐＨ值监测，以２０例健康儿作为对照组。结果：哮喘组胃食管返流发生率为５３．７％（２２／４１），显著高于对照组（０／２０）；哮喘组Ｂｏｉｘ－Ｏｃｈｏａ综合评分、酸性返流指数、返流≥５分钟次数均显著大于对照组，而ｐＨ值＜４的次数、最长返流持续时间则与对照组差异无显著意义（Ｐ＞０．０５）。提示：反复发作的哮喘患儿胃食管返流发生率较高，哮喘与胃食管返流之间有密切的关系。     

动态胃、食管双pH监测小儿胃食管反流

目的 判断小儿胃食管反流病（GERD）的类型,提高GERD的诊断率。方法 采用晶体锑双pH微电极对临床疑诊GERD患儿65例进行食管下段和胃底部pH值24h动态监测。结果 29例（44．6％）有酸性胃食管反流,4例（6．1％）有碱性胃食管反流,总检出率50．7％,两组各项反流指标与对照组相比差异有显著意义。结论 动态胃、食管双pH监测能较准确地判定反流的有无及其类型,并提高GERD的诊断率。     

动态24小时食管pH值监测小儿胃食管返流

为了解２４小时食管ｐＨ值监测在小儿胃食管返流（ＧＥＲ）诊治中的作用，研究小儿病理性ＧＥＲ的特点及其诊断标准，对５０例经钡餐造影诊为ＧＥＲ的患儿进行动态２４小时食管内ｐＨ值监测，３０例健康小儿为对照组，复查１３例病理性ＧＥＲ患儿治疗后（９例为手术治疗）的食管ｐＨ值。结果表明，ＧＥＲ组各项返流指标显著高于对照组。对照组中１例为病理性ＧＥＲ，ＧＥＲ组３１例为病理性，另１９例则为生理性。１３例食管裂孔疝（ＨＨ）患儿均有明显的病理性返流，其各项返流指标除ｐＨ值＜４次数外均显著高于单纯病理性ＧＥＲ；ＨＨ组卧位时返流≥５分钟次数、最长返流时间、总ｐＨ值＜４的时间占总观察时间的百分比和平均返流周期均显著大于立位时；单纯病理性ＧＥＲ组卧位时返流≥５分钟次数、最长返流时间和平均返流周期显著大于立位时，而返流次数则小于立位时。提示小儿病理性ＧＥＲ以卧位时明显，伴有食管裂孔疝者返流更为严重。动态２４小时食管内ｐＨ值监测可用于小儿ＧＥＲ的诊断、分析和疗效评定。     

小儿反复呼吸道感染与胃食管返流关系的探讨

目的　探讨小儿反复呼吸道感染（ＲＲＩ）与胃食管返流（ＧＥＲ） 的关系。方法　采用便携式ｐＨ 自动记录仪对３５ 例反复呼吸道感染患儿进行２４ 小时食管ｐＨ 值监测,以３０ 例健康儿为对照组。结果　ＲＲＩ组ｐＨ 值＜ ４的检出次数、返流持续时间≥５ 分钟的检出次数、最长返流持续时间、总ｐＨ＜４ 的时间占总监测时间的百分率、Ｂｏｉｘ－ Ｏｃｈｏａ 综合评分均显著大于对照组（ Ｐ＜ ０－０１） ,ＲＲＩ组胃食管返流发生率为５７－１ ％ （２０／３５）,显著高于对照组（１／３０）。结论　ＲＲＩ患儿胃食管返流的发生率高,两者之间有密切关系。     

窒息后新生儿胃食管测压及双pH监测的研究

目的探讨出生窒息对新生儿胃肠运动功能的影响。方法用多导生理记录仪测定了３５例窒息后新生儿和１７名对照新生儿的食管和胃内压力，并用晶体锑双ｐＨ微电极和便携式２４小时ｐＨ记录仪，对受试者进行了２４小时胃食管双ｐＨ动态监测。结果两组食管及胃内测压差异不显著；双ｐＨ动态监测发现，窒息组反映酸性胃食管返流的各项参数均明显高于对照组，其中酸性返流指数窒息组／对照组为７．１／１．３；返流次数为１３７．４／２８．５；返流＞５分钟的次数５．９／０．７；ｐＨ＜４总时间１５７．０／２０．１；食管廓清时间１．０／０．４，差异均有非常显著意义（Ｐ＜０．０１）。结论窒息后新生儿酸性胃食管返流较对照组明显增加，各项参数已超过病理性胃食管返流诊断标准     

动态24小时食管pH值监测小儿胃食管反流

为了解２４小时食管ｐＨ值监测在小儿胃食管返流诊治中的作用。研究小儿病理性ＧＥＲ的特点及其主仍断标准，对５０例经钡餐造影诊为ＧＥＲ的患儿进行动态２４小时食管内ＰＨ值监测，３０例健康小儿为对照组，复查１３例病理性ＧＥＲ患儿治疗后结果表明，ＧＥＲ组各项返流同于对照组。     

幽门螺杆菌相关性胃炎患儿的食管胃pH值监测及部分胃肠激素研究

目的探讨幽门螺杆菌（Ｈｐ）相关性胃炎患儿的胃肠动力变化特点。方法应用放射免疫分析和食管胃ｐＨ监测技术对５８例Ｈｐ阳性和４７例Ｈｐ阴性慢性胃炎患儿的血清胃泌素、血浆胃动素、十二指肠胃食管返流等进行了对比研究。结果Ｈｐ阳性组血清胃泌素水平高于Ｈｐ阴性组和正常对照组（ｔ值分别为３．３２６、３．８３７，Ｐ均＜０．０１）；Ｈｐ阳性组血浆胃动素水平低于Ｈｐ阴性组和正常对照组（ｔ值分别为２．５９４、４．４３２，Ｐ＜０．０５和０．０１）。Ｈｐ阳性组胃食管返流发生率为２１％，低于Ｈｐ阴性组中的４８％（χ２＝３．８１２，Ｐ＞０．０５）；Ｈｐ阳性组十二指肠胃返流发生率为５０％，高于Ｈｐ阴性组中的１３％（χ２＝７．３８３，Ｐ＜０．０１）。结论Ｈｐ感染可以导致慢性胃炎患儿血中胃泌素水平升高和血中胃动素水平降低；Ｈｐ相关性胃炎患儿胃食管返流的发生有减少的可能，十二指肠胃返流的发生显著增多     

24小时食管pH值监测在小儿支气管哮喘诊治中的应用

目的探讨胃食管返流（ＧＥＲ）与小儿支气管哮喘的关系，了解２４小时食管ｐＨ值监测在小儿哮喘诊治中的作用。方法用便携式２４小时ｐＨ自动记录仪，监测３８例支气管哮喘患儿食管下端ｐＨ值变化，３０例无症状儿为对照组，对１５例合并病理性ＧＥＲ患儿进行抗返流治疗，复查８例。结果哮喘组８项返流指标均显著大于对照组（Ｐ＜０．０１），其病理性ＧＥＲ的检出率为３９％（１５／３８），显著高于对照组（１／３０）（Ｐ＜０．０１）；小儿哮喘合并病理性ＧＥＲ者其返流以卧位和夜间时严重；经雷尼替丁抗返流治疗后，各项返流指标除了立位ｐＨ＜４时间百分比外，均显著下降（Ｐ＜０．０１或＜０．０５），近期随访结果显示，哮喘得到有效控制。结论ＧＥＲ是诱发小儿哮喘发作的一个重要因素，哮喘合并病理性ＧＥＲ的患儿对制酸药物抗返流治疗有良好的反应，２４小时食管ｐＨ值监测在小儿哮喘的病因诊断和疗效观察上有重要的应用价值。     

24 Сʱθʳ�ܶ�̬˫pH ��⼼����������θʳ�ܷ�����ؼ����е�Ӧ��

??The 24-hour intraesophageal pH monitoring is a widely used method in diagnosis of gastroesophageal reflux diseases. It has been regarded as the diagnositic standard of these diseases. Due to the technical limitation?? the traditional pH monitoring can only show the acid refluxes in the lower esophagus instead of the mixed and alkaline ones. As a result?? there is inevitably a proportional rate of misdiagnosis in the traditional pH monitoring. The 24-hour gastric and esophageal double pH monitoring can perfectly solve this problem. In this method?? both the gastric and esophageal pH is recorded for 24 hours. Both the acid refluxes in the lower esophagus and the duodenogastric reflux and the mixed and alkaline refluxes can be clearly demonstrated. With improvement of accuracy?? the 24-hour gastric and esophageal double pH monitoring has been used in adults and adolescent?? but rarely in the neonates. In this paper??the key point of this method and its application in neonates and prematures was reviewed and introduced.     

Esophageal pH monitoring and impedance measurement: a comparison of two diagnostic tests for gastroesophageal reflux

BACKGROUND: pH monitoring is the standard diagnostic tool for gastroesophageal reflux in infants. However, this method does not document the reflux of all kinds of fluid from the stomach into the esophagus, but only documents acid material. The parameters that define reflux episodes by pH monitoring have been derived empirically from observations of many infants considered healthy and ill. Acid reflux is a continuum, some reflux is normal and doubt exists as to how much reflux is abnormal. In this study, one of the standardized protocols for analyzing pH recordings was evaluated and compared with simultaneously obtained intraesophageal impedance measurement (IMP), a pH-independent method of detecting bolus movement within the esophagus. METHODS: The esophagi of 50 infants with reflux symptoms were measured, using both standard pH probe and multiple-site impedance measurement. A standard protocol for analyzing esophageal pH records was used. The sampling rate for pH values was 15/min. Acid reflux was defined as pH less than 4.0 (threshold pH) for at least 15 seconds (minimal duration) with at least 30 seconds (latency time) between separate episodes. The software used could adjust independently or in combinations the sampling rate and these reflux criteria. Thereby it was determined whether changes in the criteria for acid reflux improved the sensitivity and predictive value of pH monitoring when compared with reflux episodes defined by IMP. RESULTS: During 318 hours of recording in 50 infants, 1,887 episodes of reflux occurred according to IMP. Only 282 (14.9%) of the IMP-determined episodes were acid reflux episodes. No alkaline reflux episodes occurred. Among the 270 pH probe-determined episodes using the standard criteria of acid reflux, only 153 (sensitivity, 54.3%; positive predictive value, 56.7%) were accompanied by unmistakable retrograde bolus movement using IMP measurements. Retrograde bolus movement did not accompany the other 117 episodes. Using a sampling rate of 15/min, a pH threshold of 4.0, a minimal duration of reflux episodes of 8 seconds, and a latency time of 60 seconds, the positive predictive value of pH probe results increased to 60.7%. Variations in the sampling rate or criteria for defining acid reflux did not significantly improve the accuracy of the pH probe results versus IMP-defined episodes. CONCLUSIONS: Most reflux episodes that occur in infants are undetectable by standard pH probe monitoring. pH monitoring does not detect all reflux in the esophagus but is useful for detecting acidity in the esophagus and determining the duration of its presence. Combining pH monitoring with impedance measurement is a valuable diagnostic tool for gastroesophageal reflux in infants.     

Oesophageal pH monitoring and reflux oesophagitis in irritable infants

Acid reflux and/or oesophagitis may be responsible for inconsolable crying in infants. We evaluated prospectively the presence of acid reflux disease, oesophagitis and the accuracy of pH monitoring in the prediction of oesophagitis in a population of irritable infants. A 24-h oesophageal pH monitoring with a glass electrode and an upper gastro-intestinal tract endoscopy with grasp biopsies were performed in 60 irritable infants, aged 1 to 6 months, not responding to cows milk elimination. The 24-h oesophageal pH monitoring was considered abnormal in 40/60 (66%) babies and histological oesophagitis was present in 26/60 (43%). In the infants with histological oesophagitis, the reflux index (% of the investigation time with a pH <4.0) was >5% in 18/26 (69%). Histology of the oesophagus was normal in 22 of the 40 (55%) infants with an abnormal pH monitoring. The mean reflux index in the group with oesophagitis (12.20%) was significantly higher than in the group with normal histology (8.74) ( P =0.036), although there was an important overlap. The sensitivity and specificity to predict oesophagitis with a reflux index of 5.0% or more was 69.2 and 35.3, respectively. There was not a reflux index which could be related to a clinically useful sensitivity and specificity to predict oesophagitis. Conclusion:acid gastro-oesophageal reflux disease and/or histological oesophagitis were diagnosed in 66% and 43% of irritable infants, respectively. There was no relation between symptoms and abnormal pH metry or oesophagitis; however, the reflux index does not accurately predict oesophagitis and normal histology does not accurately exclude acid gastro-oesophageal reflux disease. Oesophageal pH monitoring and endoscopy provide additional information.Abbreviations GOR gastro-oesophageal reflux - RI reflux index     

Gastro-oesophageal reflux in children: comparison of different durations,positions and sleep-awake periods of pH monitoring in the same patient

A group of 72 children (mean age: 21.7 months, range: 14 days–19 years) with symptoms of gastrooesophageal reflux were investigated by 22 h pH monitoring. Using a Proxeda software, we compared, in the same patient, the specificity and sensitivity of pH monitoring during 3 h, 6 h, 12 h, 12 nocturnal hours and 3 postprandial hours, as well as the influence of position and the sleep and alert periods. Results showed that all the short pH monitorings were statistically less sensitive than 22 h pH monitoring (P<0.025). As regards specificity, only the 12 nocturnal hours pH monitoring was not statistically different from the 22 h pH monitoring. Gastro-oesophageal reflux was more frequent when the patient was awake than during sleep. pH monitoring seemed more reliable in the recumbent than in the upright position. We conclude that long-term pH monitoring (22 h) is the test of choice to diagnose gastro-oesophageal reflux because it included sleep and alert periods as well as different positions.     

Seventeen-hour continuous esophageal pH monitoring in the newborn: evaluation of the influence of position in asymptomatic and symptomatic babies

Esophageal pH monitoring has been performed in 60 asymptomatic neonates between 1 and 10 days old. Several parameters (periods with a pH less than 4, number of reflux episodes, number of reflux episodes lasting more than 5 min, average duration of the longest reflux episode, average pH) were studied in different positions (in prone and supine position, in right and left side lying position). For all parameters, except for the average pH, we obtained significantly more favorable results in prone position. In 22 vomiting neonates, significantly favorable results were obtained only by application of positional therapy: in prone position with head elevated (anti-Trendelenburg). There was no significant difference between the symptomatic group (with radiologically proven reflux pathology) in prone and anti-Trendelenburg position, and the control group in prone horizontal position. The 17-h continuous pH monitoring in the newborn is a nonaggressive investigation technique in physiological circumstances, which adequately completes and/or replaces the traditional examinations on gastroesophageal reflux. This method enables an evaluation of the favorable effect of simple therapeutic means (positional changes). Medication, and thickening and staggering of feeding (a time-consuming and tiring burden for the parents), can be avoided with this technique.     

Diagnostic accuracy of pH monitoring in gastro-oesophageal reflux.

One hundred and eleven children admitted with suspected gastro-oesophageal reflux were studied, with 24 hour oesophageal pH monitoring as the first line of investigation. Barium swallow examination, or oesophagoscopy, or both, were carried out only in children with abnormal pH, who subsequently had a trial of 1-12 months medical treatment. All patients were followed up for eight months to two years. A final diagnosis of gastro-oesophageal reflux was made in 41 patients, in all of whom the pH study was abnormal (100% sensitivity). The final diagnosis was different in 70 patients; 66 of these had a normal pH (94% specificity). All children with gastro-oesophageal reflux were treated with drugs. All those with a percentage reflux time of more than 27 and more than 20 episodes of reflux lasting more than 5 minutes failed to improve and needed operation. We conclude that monitoring of the oesophageal pH should be the first line of investigation in patients with gastro-oesophageal reflux and should be used together with clinical data and other investigations, to identify those children who will need operation.     

Evaluation of infantile acid and nonacid gastroesophageal reflux using combined pH monitoring and impedance measurement

OBJECTIVE: Characterize the proportion of acid and nonacid esophageal reflux events in young infants with suspected gastroesophageal reflux (GER) using combined pH-multichannel intraluminal impedance (MII) monitoring. Determine the symptom index correlation with nonacid reflux and acid reflux events. STUDY DESIGN: Prospective study of children, aged 2 weeks to 1 year, referred to The Children's Hospital of Denver Gastroenterology Clinic for evaluation of GER. Exclusion criteria were congenital anomalies or syndromes, cerebral palsy, mental retardation, and pulmonary or cardiac disease. The children were admitted to The Children's Hospital General Clinical Research Center for a 20 hour pH-MII study. Acid suppression was either never used or discontinued 2 weeks before testing. RESULTS: Thirty-four infants were enrolled from February 2004 to February 2005. Ages ranged from 2 months to 11 months, median = 7 (20 females/14 males). One thousand eight hundred ninety reflux events were detected by MII, and 588 reflux events were detected by pH probe alone. The percent of reflux that was acid was 47% (888 events) versus 53% of (1,002 events) nonacid reflux events. The proportion of nonacid reflux decreased with age (P < 0.0001 by Pearson chi test) and with increasing time elapsed from last meal. There were 958 total symptoms evaluated. The most frequently reported symptom was fussiness/pain, which correlated with nonacid reflux events 24.6% and acid reflux 25.2%. The proximal height of a reflux was predictive for symptoms of fussiness/pain, arching, and burping. CONCLUSION: MII detects more reflux events than pH monitoring alone. The proportion of nonacid reflux to acid reflux events in infants is more similar to adults than previously reported. Combined pH-MII esophageal monitoring identifies more reflux events and improves clinical correlation with symptoms.     

Simultaneous tracheal and oesophageal pH monitoring during mechanical ventilation

OBJECTIVE: To simultaneously record tracheal and oesophageal pH in mechanically ventilated children to determine: (1) the feasibility and safety of the method; (2) the incidence of gastro-oesophageal reflux (GOR) and pulmonary contamination; and (3) their associated risk factors. DESIGN: Prospective study. SETTING: Paediatric intensive care unit in a university hospital. PATIENTS: Twenty mechanically ventilated children (mean age 6.7 years) who met the following inclusion criteria: endotracheal tube with an internal diameter of 4 mm or more (cuffed or uncuffed), mechanical ventilation for an acute disease, no treatment with antiacids, prokinetics, or H2-receptor blockers, and no nasogastric or orogastric tube. METHODS: The tracheal antimony pH probe was positioned 1 cm below the distal end of the endotracheal tube. The oesophageal antimony pH probe was positioned at the lower third of the oesophagus. pH was recorded on a double channel recorder and analysed with EsopHogram 5.01 software and by examination of the trace. The following definitions were used: GOR index, percentage of time pH < 4; pathological GOR, GOR index > 4.8%; tracheal reflux, fall in tracheal pH < 4, 4.5, or 5, or a decrease of one unit from baseline, in both cases preceded by an episode of GOR. The results were analysed statistically by Fisher's exact and the Kruskal-Wallis test. RESULTS: The procedure was well tolerated and the median duration of analysable recording was 6 hours (range 5-22.6). Pathological GOR was observed in eight (40%) children. GOR was more frequent with an uncuffed endotracheal tube than with a cuffed one (p = 0.01). Tracheal reflux (pH < 4) was observed in four children (20%) without clinical evidence of pulmonary aspiration. Episodes of tracheal reflux were associated with a GOR index > 10% (p < 0.01) and were more frequent with a maximal inspiratory pressure of < 25 cm H2O (p = 0.03), but were not related to the indication for mechanical ventilation, whether the endotracheal tube was cuffed or not, age, or drug treatment. CONCLUSIONS: Simultaneous tracheal and oesophageal pH monitoring was feasible in the setting of this study. Tracheal reflux can occur without pathological GOR, and GOR may occur without tracheal reflux. Further prospective studies in larger groups of patients are now justified.     

Will esophageal impedance replace pH monitoring?

Esophageal impedance, a technique based on the fact that the passage of a bolus changes the impedance between esophageal segments, is being used more and more. Multiple esophageal impedance combined with pH monitoring is advocated to become the preferred technique to measure acid and nonacid gastroesophageal reflux. Compared with pH monitoring, impedance has the advantage of being independent of pH and, as a consequence, is better adapted to measure reflux (especially in the postprandial period when reflux is buffered) and detect symptoms associated with nonacid- or weakly acid-reflux episodes. Conversely, the analysis of an impedance tracing requires more time and knowledge than a pH tracing and is possibly subjected to higher interobserver variability. Day-to-day reproducibility and interobserver variability are considerable. Episodes detected only by pH monitoring or impedance are numerous in pediatrics; therefore, pH monitoring and impedance should be associated in analyses of multiple esophageal impedance combined with pH monitoring. Up to now, there has been a striking absence of literature showing attempts to link data from diagnostic procedures to clinical outcome in symptomatic patients. Furthermore, data suggesting that impedance does offer a clear-cut benefit in pediatric clinical routine are missing. High cost of the material and the investment in time necessary for interpretation of the recording remain a handicap. However, because pH monitoring is part of impedance technology, it is likely that the latter will soon replace pH monitoring despite the current need of scientific evidence demonstrating a relation between symptoms, esophageal damage or response to reflux treatment, and results of multiple esophageal impedance combined with pH monitoring.