Accuracy and reproducibility of 12-h esophageal pH monitoring

Seventy-five consecutive 24-h intraesophageal pH recordings performed according to the methods of Jolley et al. were evaluated. Total scores and the mean duration of sleep reflux (ZMD) were calculated for the first and the last 12 h, respectively, and compared to each other, as well as to the full 24-h recording. The accuracy of the first and last 12 h in predicting whether the 24-h study was abnormal was 85% and 87%, respectively. The accuracy in predicting whether the ZMD for the 24-h study was abnormal was 73% and 83%, respectively, with an overall 39% false-negative rate. The 12-h study reproducibility was 72% for the total score and 56% for the ZMD. Since the original standards were determined from 18- to 24-h recordings, the test was restandardized based on 12-h recordings from patients with normal 24-h studies. Restandardization did not improve the accuracy or reproducibility. The high false-negative rate for the ZMD and the poor reproducibility cast serious doubt on the utility of 12-h pH recordings, especially in patients with respiratory symptoms.     

Area under pH 4: advantages of a new parameter in the interpretation of esophageal pH monitoring data in infants

Twenty-four-hour continuous esophageal pH monitoring has become the preferred test to quantify acid gastroesophageal reflux. Agreement has been achieved that acid gastric content reflux into the esophagus constitutes a major cause of reflux esophagitis; we therefore calculated the "area under pH 4" (A) in 560 consecutive pH monitorings in infants 1-12 months old and related this parameter (A) to the reflux index (RI): RI less than 10%: A 185 +/- 295 (mean +/- 1 SD); RI 10-19%: A 1,046 +/- 1,206; RI 20-29%: A 1,967 +/- 2,038; RI 30-39%: A 3,307 +/- 2,955; RI greater than 40%: A 7,977 +/- 7,227. A higher RI is associated with a greater area under pH 4 (p less than 0.001); the high SD obtained in each group, however, illustrates the great variability in surface (or acidity of the reflux episodes) in all groups. Esophagoscopy and biopsy were performed in 112 infants (20%). Specificity in the prediction of (mild) esophagitis was higher for the area under pH 4 (88%) compared with the RI (50%). The sensitivity of both parameters was comparable (96 versus 93%). Our results strongly suggest that in young infants, the acidity of the reflux episodes (the area under pH 4) is a determining factor in the prediction of esophagitis. These data need to be confirmed by more studies before general application of this parameter can be advised.     

Esophageal pH monitoring for detecting gastroesophageal reflux in children with repaired esophageal atresia

Gastroesophageal reflux (GER) is a common problem in children who were operated upon for esophageal atresia. Reflux can cause serious complications in these children; therefore, it would be of value to identify patients at risk at an early stage. From October 1987 to January 1989, 12 infants with esophageal atresia were operated upon at St Göran's Department of Pediatric Surgery and then followed with ph monitoring at the ages of 1,3,6, and 12 months. At 1 month of age, 5 children had a reflux index of 5% or more; 4 of these 5 developed symptoms of GER. None of the children who had a reflux index of less than 5% showed any symptoms of reflux.It is concluded that pH monitoring at the age of approximately 1 month in children who have been operated upon for esophageal atresia may identify patients belonging to a risk group, who need closer follow-up for symptoms of reflux. Offprint requests to: M. Montgomery     

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。     

Value of simultaneous monitoring of esophageal and gastric pH in infants

Simultaneous monitoring of esophageal and gastric pH in infants makes clear some peculiarities of digestive physiology and improves the sensibility of the simple method, usual mean of diagnosis of GER. In that way, a gastro-esophageal pH gradient is showed; gradient absolutely necessary to a good interpretation of this test. In twenty-two infants, younger than one year, continuous and extended monitoring of esophageal and gastric pH was realised with a specially-designed-combination microelectrode. Results pointed out that, after a meal, especially a milked meal, the post prandial period isn't suitable for the diagnosis of GER. Indeed, the gastric acidity is buffered, sometimes during many hours: that decreases or cancels the gastro-esophageal pH gradient. Besides, transient neutralisation periods of gastric acidity may occur, perhaps related with duodenogastric-biliary reflux. Before two months, the gastric pH is less acid that involves, one more time, on insufficient gastro-esophageal pH gradient for the diagnosis of GER.     

24 h食管pH监测在婴儿难治性肺炎中的临床应用研究

目的探讨24h食管pH监测在婴儿难治性肺炎中的临床应用及其意义。方法对57例难治性肺炎患儿进行24h食管pH监测,监测指标包括食管pH〈4.0的次数、反流时间≥5min的次数、最长反流时间、卧位pH值〈4的时间占总监测时间的百分比和Biox-Ochoa评分。结果57例中存在胃食管反流（GER）28例（占49.1%）;有呕吐与无呕吐症状患儿各项反流指标比较差异有统计学意义;伴有胃食管反流患儿经促动力剂治疗者,肺部罗音消失时间和咳嗽持续时间均较未用促动力剂治疗者短,差异有统计学意义（P〈0.05）。结论难治性肺炎患儿经正规抗炎治疗效果不佳者,应考虑是否合并胃食管反流,进行24h食管pH监测,以确定病因并指导治疗。     

Do esophageal pH monitoring data depend on recording equipment and probes?

Esophageal pH monitoring data are influenced by numerous patient- and/or technical equipment-related factors. In this study, data obtained with 10 pH recording devices of two different companies and 10 pH glass-microelectrodes with an external reference electrode of one company, calibrated by different persons, were compared. Pearson correlation coefficients regarding the reflux index (the percentage of the investigation time with a pH less than 4) ranged from 0.93 to 1.00. The lowest correlation coefficient (0.73) was obtained by comparing the number of episodes with a pH less than 4 recorded with devices from different companies. These results suggest that differences in pH monitoring data recorded in comparable conditions with one type of pH electrode are irrelevant as far as clinical routine investigations are concerned. Data are not significantly influenced by the recording devices themselves, the age of the electrodes, or the skin-potential differences induced by the person calibrating the probes.     

The yield of esophageal pH monitoring during polysomnography in infants with sleep-disordered breathing

This study evaluates the yield of adding simultaneous esophageal pH monitoring to polysomnography (PSG) in 41 infants with unexplained sleep disordered breathing. The relationships of respiratory events to episodes of gastroesophageal reflux (GER) were analyzed. The major causes for referring the infants were cyanotic episodes (22%), apneas (20%), and choking events (15%). PSG was abnormal in 8/41 (20%). Abnormal pH studies were observed in 12/41 (29%) infants. In 4/12 (33%), respiratory events correlated with GER episodes. Adding simultaneous pH monitoring to PSG may identify associated conditions and thus focus treatment.     

Effect of cisapride on esophageal pH monitoring in children with reflux-associated bronchopulmonary disease

Clinical evaluation and prolonged esophageal pH monitoring were performed before and during treatment with cisapride (0.3 mg/kg t.i.d.) for 1 month in 19 children with reflux-associated bronchopulmonary disease. Results (mean +/- SEM) show that cisapride significantly decreases the frequency of long duration (greater than 5 min) reflux episodes (from 9.7 +/- 0.7 to 5.7 +/- 1.2), the percentage of total time pH was less than 4 (from 15.9 +/- 2.5 to 7.7 +/- 1.1%), the percentage of time pH was less than 4 at night (from 18.0 +/- 3.9 to 4.9 +/- 1.5%), the duration of the longest reflux episodes (from 44.5 +/- 6.4 to 19.7 +/- 2.7 min), as well as the duration of reflux at night (from 100.1 +/- 28.0 to 28.2 +/- 10.1 min). The frequency of reflux episodes, however, remains unaffected by cisapride. Cough fits at night disappeared completely in 12 out of 13 children. We conclude that cisapride given for 1 month significantly decreased gastroesophageal reflux as well as cough episodes at night.     

24Сʱʳ�ܶ�̬pH-�迹���ϼ������С��θʳ�ܷ����Կ��Ե��ٴ�����

??Abstract??Objective To investigate the characteristics of gastroesophageal reflux disease ??GERD?? with chronic cough by 24-hour ambulatory esophageal impedance-pH monitoring in children. Methods From February 2012 to July 2013?? 40 cases of inpatients and outpatients in Nanjing Children′s Hospital Affiliated to Nanjing Medical University?? who were suspected with gastroesophageal reflux cough ??RERC????were recruited??all these cases underwent 24-hour ambulatory esophageal impedance-pH monitoring. Results Among the 40 children with chronic cough?? 23 patients were diagnosed with GERD refering to pH monitoring??34 children were diagnosed with GERD by 24-hour ambulatory esophageal impedance-pH monitoring. Esophageal acid reflux were significantly higher in the upright than supine position ??P??0.05????and the characteristics of GERD with chronic cough was mainly weak acidic reflux and acid reflux in the upright ??P??0.05????the mixed reflux was the highest frequency in the upright ??P??0.05??. There was no difference between in the upright and supine position about the bolus clearance time??proximal reflux in the supine position was the main way in the total reflux ??P??0.05??. The total reflux and SI demonstrated positive correlation??r = 0.818?? P??0.05??. Conclusion Acid reflux?? weak acid reflux and non-acid reflux can be detected by 24-hour ambulatory esophageal impedance-pH monitoring. The 24-hour ambulatory esophageal impedance-pH monitoring can make more accurate diagnosis of GERD in chronic cough children??and it may have a good prospect for clinical application.     

Esophagitis in distressed infants: poor diagnostic agreement between esophageal pH monitoring and histopathologic findings

OBJECTIVES: Our purpose was to study the relation between gastroesophageal reflux (GER) and esophagitis in infants with persistent distress. STUDY DESIGN: Infants (n = 125, 79 boys; median age, 4.2 months) with persistent distress and clinical symptoms suggestive of GER and esophagitis were retrospectively studied. All had undergone esophageal 24-hour pH monitoring and had upper gastrointestinal biopsy specimens taken. RESULTS: There were 65 (48%) infants with inflammatory changes found in at least one upper gastrointestinal biopsy specimen, of whom 32 (25.6%) had esophagitis; 11 infants with esophagitis also had gastritis or duodenitis. Although infants with frequent regurgitation (n = 65) had significantly more frequent GER episodes per 24 hours (P <.03) and greater fractional reflux time (P <.001) than infants without, this was not associated with histologic esophagitis (P =.33). Of the 32 infants with esophagitis, 9 had abnormal pH monitoring and 23 had nonreflux esophagitis. A separate group of 23 infants had abnormal pH monitoring but no esophagitis. Diagnostic agreement between pH monitoring and esophageal histologic features was poor (kappa = 0.07). CONCLUSION: Esophagitis occurred in one quarter of infants with persistent distress. Abnormal esophageal pH monitoring did not reliably predict esophagitis, suggesting a nonacid peptic cause in some of these infants.     

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.     

Continuous 24-hour esophageal pH monitoring in 285 asymptomatic infants 0-15 months old

A continuous 24-h esophageal pH monitoring was performed in 283 asymptomatic infants between 5 days and 15 months old. Several parameters (reflux index, duration of the longest reflux episode, number of reflux episodes in 24 h, number of reflux episodes greater than 5 min in 24 h) were studied in different groups of infants according to their age: 5-15 days old, 24-37 days old, 3.5-4.5 months old, 5.5-6.5 months old, 7.5-8.5 months old, 14-16 months old. For all parameters we obtained statistically significant different results in infants younger and older than 4 months. The 24-h esophageal pH monitoring is an investigation technique in physiological circumstances in order to establish normal ranges for gastroesophageal reflux in asymptomatic infants.