Department of Pediatrics, National Taiwan University Children's Hospital and College of Medicine, National Taiwan University, No. 8, Chung Shan South Road, Taipei, 100, Taiwan.
J Gastroenterol. 2013 Nov;48(11):1242-8. doi: 10.1007/s00535-013-0750-0. Epub 2013 Feb 9.
The role of combined multichannel intraluminal impedance and pH monitoring (MII-pH) in diagnosing sliding hiatal hernia in gastroesophageal reflux disease (GERD) children remains unclear. We aimed to explore the clinical efficacy of MII-pH as a supplement diagnostic method for sliding hiatal hernia.
A total of 104 symptomatic GERD children [mean ± standard deviation (SD) age = 4.5 ± 5.5 years] were recruited. All of them were diagnosed as GERD with and without sliding hiatal hernia by barium and/or esophagogastroduodenoscopy study. All subjects received 24 h MII-pH monitoring to test the efficacy of this new modality.
Sixteen children were diagnosed to have sliding hiatal hernia, and nine (56.3%) of them received fundoplication. None of non-hiatal hernia children were indicated for fundoplication [risk difference (RD) 0.56; P < 0.001]. Impedance probes detected more reflux episodes than pH-probe in the whole study population (mean ± SD = 62.1 ± 47.8 vs. 47.8 ± 48.1 episodes; P = 0.02, paired t test). Due to the presence of pH-only reflux, the reflux episodes detected by impedance probes is less than that by pH probe in sliding hiatal hernia children (mean ± SD = 49.2 ± 78.9 vs. 103.7 ± 60.4 episodes; P = 0.01, paired t test). Ratio of reflux episodes detected by pH-probe to that by impedance probes >1 was more frequently noted in sliding hiatal hernia children than non-sliding hiatal hernia children (Odds ratio 58.33, P < 0.001). The sensitivity and specificity of this diagnostic tool to predict sliding hiatal hernia in GERD children are 93.8 and 79.6%, respectively.
Ratio of reflux episodes detected by pH-probe to that by impedance probes >1 demonstrated by MII-pH study is a good screening test of sliding hiatal hernia in GERD children.
联合多通道腔内阻抗和 pH 监测（MII-pH）在诊断胃食管反流病（GERD）儿童滑动性食管裂孔疝中的作用尚不清楚。我们旨在探讨 MII-pH 作为滑动性食管裂孔疝补充诊断方法的临床疗效。
共纳入 104 例有症状的 GERD 儿童[平均年龄±标准差（SD）=4.5±5.5 岁]。所有患儿均通过钡餐和/或食管胃十二指肠镜检查诊断为 GERD 伴或不伴滑动性食管裂孔疝。所有患儿均接受 24 h MII-pH 监测以评估该新方法的诊断效能。
16 例患儿诊断为滑动性食管裂孔疝，其中 9 例（56.3%）患儿接受了胃底折叠术。无食管裂孔疝患儿需要接受胃底折叠术[风险差异（RD）0.56；P＜0.001]。阻抗探头在全组研究人群中检测到的反流事件多于 pH 探头（均值±SD=62.1±47.8 比 47.8±48.1 次；P=0.02，配对 t 检验）。由于存在仅 pH 反流，滑动性食管裂孔疝患儿中阻抗探头检测到的反流事件少于 pH 探头（均值±SD=49.2±78.9 比 103.7±60.4 次；P=0.01，配对 t 检验）。pH 探头检测到的反流事件与阻抗探头检测到的反流事件比值＞1 在滑动性食管裂孔疝患儿中更为常见，而非滑动性食管裂孔疝患儿中则不常见（比值比 58.33，P＜0.001）。MII-pH 检测预测 GERD 患儿滑动性食管裂孔疝的敏感性和特异性分别为 93.8%和 79.6%。
MII-pH 研究中 pH 探头检测到的反流事件与阻抗探头检测到的反流事件比值＞1 是 GERD 儿童滑动性食管裂孔疝的良好筛查试验。
