Gunasagaran Hema Lattha, Varjavandi Vincent, Lemberg Daniel A, Ooi Chee Y, Gupta Nitin, Krishnan Usha
Department of Medicine, University of New South Wales, Sydney, NSW, Australia.
Department of Paediatric Surgery, Sydney Children's Hospital, Sydney, NSW, Australia.
Acta Paediatr. 2020 Dec;109(12):2799-2807. doi: 10.1111/apa.15317. Epub 2020 May 8.
To determine whether combined multichannel intraluminal impedance and pH (MII-pH) testing led to a change in management of children with gastro-oesophageal reflux disease (GORD).
Retrospective chart review was done in all patients who underwent MII-pH testing for GORD symptoms at Sydney Children's Hospital between 2008 and 2016. Changes to anti-reflux medications and referral for anti-reflux surgery were evaluated.
There were 365 patients, 260 (71.2%) of whom were on acid-suppressing therapy. The median age was 4.1 ± 4.8 years, 205 patients (56%) were males, 83 (22.7%) were infants (<1 year of age) and 145 (39.7%%) had comorbid conditions. We found 72.1% had abnormal MII-pH results, of which 17.5% had abnormal acid reflux, 8.2% had abnormal number of retrograde bolus movements and 46.3% had hypersensitive oesophagus (positive symptom association only). Infants were significantly more likely to have abnormal MII-pH results compared to older children (P = .04). Results of MII-pH testing led to medication changes in 44.7% and referral for anti-reflux surgery in 6.8% of patients.
Combined multichannel intraluminal impedance and pH testing is clinically useful in the management of children with symptoms of GORD and over half the patients had changes to their medical treatment or referral for anti-reflux surgery based on the results of MII-pH testing. It resulted in a treatment change in an additional 32% of patients over traditional pH-metry.
确定联合多通道腔内阻抗与pH值（MII-pH）检测是否会改变胃食管反流病（GORD）患儿的治疗管理。
对2008年至2016年间在悉尼儿童医院因GORD症状接受MII-pH检测的所有患者进行回顾性病历审查。评估抗反流药物的变化以及抗反流手术的转诊情况。
共有365例患者，其中260例（71.2%）正在接受抑酸治疗。中位年龄为4.1±4.8岁，205例（56%）为男性，83例（22.7%）为婴儿（<1岁），145例（39.7%）有合并症。我们发现72.1%的患者MII-pH检测结果异常，其中17.5%有酸反流异常，8.2%有逆行推注运动次数异常，46.3%有食管过敏（仅症状关联阳性）。与大龄儿童相比，婴儿MII-pH检测结果异常的可能性显著更高（P = 0.04）。MII-pH检测结果导致44.7%的患者药物治疗改变，6.8%的患者转诊接受抗反流手术。
联合多通道腔内阻抗与pH值检测在GORD症状患儿的治疗管理中具有临床实用性，超过半数的患者基于MII-pH检测结果改变了药物治疗或转诊接受抗反流手术。与传统pH测量法相比，它使另外32%的患者治疗发生改变。
