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- Title
pH-impedance monitoring value in diagnosis of gastroesophageal reflux in children and teenagers - preliminary report.
- Authors
Szaflarska-Popławska, Anna; Mierzwa, Grażyna; Bała, Grażyna; Parzȩcka, Monika; Kuczyńska, Renata
- Abstract
Aim of study: The aim of the study was assessment concerning pH-impedance usefulness in diagnostics of gastroesophageal reflux (GER) in children and teenagers. Material and methods: 53 children and teenagers were included into the study, aged from 7 to 18 years (the average age - 15 years), comprising 36 females and 17 males with clinical symptoms suggesting GER. 24-h pH-impedance monitoring was performed using device and polyvinyl probes for adult patients (Sandhill Scientific Inc., Colorado, USA). The following data were considered during recording analysis: total number of refluxes, number of acid and non-acid refluxes, the total, upright and recumbent all reflux percent time (measured by impedance), the total, upright and recumbent acid percent time (detected by impedance and categorized as acid by pH), total, upright and recumbent acid exposure percent time, DeMeester score (detected by pH electrode) and reflux symptom index (RSI) concerning relationship of particular coded clinical symptoms. Results: Total number concerning all GER events, diagnosed using pH-impedance analysis, was 4044 (on average - 76.3), including 2504 acid refluxes (61.9%) (on average - 47.2), but 1540(38.1%) non-acid refluxes (on average - 29.1). Acid GER was found together in 18 children (34%), non-acid reflux in 6 patients (11.3%), but mixed reflux in 15 children (28.3%). 14 patients (26.4%) were excluded to suffer from GER. Concerning the group of patients without GER, the number of non-acid refluxes ranged from the limit of 5 to 24 (on average - 13.1). The number of non-acid events in the group of patients with non-acid reflux ranged from the limit of 10 to 56 (on average - 34), but within the limit from 33 to 135 (on average - 61.3) in the group with mixed reflux. Results of pH-impedance analysis and classical pH-metry were conformable in 41 patients (77.4%). Considering the group of patients who presented particular clinical symptoms during recording the most significant relationship with GER was observed in case of heartburn (9/14 of patients), burning sensation in the throat (2/3 of the patients) and belching (8/15 of the patients). Relationships concerning clinical symptoms and reflux events were found both in patients with acid GER (11/18 of patients), non-acid GER (4/6 of patients) and mixed (8/14 of patients). Conclusions: pH-impedance analysis permits to distinguish patients with GER (acid, non-acid, mixed) and without reflux in the group of children and teenagers with clinical symptoms suggesting GER. Shortage of consistence concerning pH-impedance analysis and classical pH-metry is present among every fourth patient with symptoms suggesting GER. The percentage of non-acid reflux in children and teenagers with typical symptoms of GER is nearly 40% of all incidents. Heartburn, belching and burning sensation in the throat are the most frequent symptoms connected with reflux incidents and reported by children and teenagers. Over half of symptoms registered by children and teenagers during pH-impedance analysis have no relation to reflux incidents. Acid and non-acid reflux events can have a similar clinical manifestation. Difficulties concerning interpretation of pH-impedance analysis results in children and teenagers ensue from the absence of paediatric normal ranges and from the problems with recording clinical symptoms.
- Subjects
GASTROESOPHAGEAL reflux; GASTROESOPHAGEAL reflux in children; CELLULAR pathology; ESOPHAGUS diseases; HEARTBURN
- Publication
Gastroenterologia Polska / Gastroenterology, 2007, Vol 14, Issue 4, p251
- ISSN
1232-9886
- Publication type
Article