The Correlation between Endoscopic Reflux Esophagitis and Combined Multichannel Intraluminal Impedance-pH Monitoring in Children.

BACKGROUND

Gastroesophageal reflux (GER) is the retrograde flow of gastric contents into the esophagus and may induce a variety of complications. Endoscopically visible breaks in the distal esophageal mucosa are the most reliable evidence of reflux esophagitis. Combined multichannel intraluminal impedance and pH-metry (MII-pH) is a technique that enables monitoring of GER independent of its acidity. The aim of this study is to investigate the GER patterns in children with the aid of MII-pH monitoring and determine the correlation between endoscopically proven reflux esophagitis and reflux types by MII-pH monitoring.

METHODS

One hundred and twenty children were enrolled from January 2010 to October 2011 for MII-pH monitoring. We studied the GER patterns by means of pH (acid and nonacid reflux) and composition (liquid, mixed, and gas reflux) by the esophageal MII-pH signals. Meanwhile, 34 (28.3%) patients received esophagogastroduodenoscopy examination at the same time. The severity of reflux esophagitis was graded with Los Angeles classification.

RESULTS

MII-pH monitoring significantly increased the detection of numbers of reflux compared with traditional 24-hour pH monitoring (p < 0.001). The significant cutoff value of MII-pH parameters including DeMeester score ≥ 21, duration of longest acid reflux ≥ 17 minutes, and occurrence of acid reflux for more than 5 minutes showed good correlation in the prediction of the presence of endoscopic reflux esophagitis. The odds ratios of the above mentioned parameters were 12.6, 8.94, and 7.5, respectively (p = 0.02, p = 0.01, and p = 0.01). Furthermore, ≥ 3 episodes per day of acid reflux for more than 5 minutes can predict the occurrence of severe reflux esophagitis (odds ratio 12.78, p = 0.009).

CONCLUSION

MII-pH monitoring not only raised the diagnostic yield in identifying GER, but it also showed significant correlation with the presence of endoscopically proven reflux esophagitis in children.