Sequeira Gomes Rochelle, Favara Michael, Abraham Sheeja, Palma Joan Di, Aghai Zubair H
Department of Neonatology, Thomas Jefferson University/Nemours, Philadelphia, Pennsylvania.
Department of Pediatric Gastroenterology and Nutrition, Thomas Jefferson University/Nemours, Philadelphia, Pennsylvania.
Am J Perinatol. 2025 Mar;42(4):486-494. doi: 10.1055/a-2405-1545. Epub 2024 Aug 29.
This study aimed to assess the use of combined multichannel intraluminal impedance and pH studies (MII-pH) in a large group of symptomatic young infants, to characterize the occurrence of gastroesophageal reflux disease (GERD), and to establish temporal association of the reflux behaviors with gastroesophageal reflux using symptom indices.
This is a retrospective cohort study on 181 infants who underwent MII-pH studies for clinical behaviors that were suggestive of GERD. Symptom index (SI) and symptom association probability (SAP) were used to establish symptom association with reflux. More than 100 GER episodes in 24 hours or acid reflux index > 10% was considered pathological reflux.
A total of 181 infants (median age: 60 days, interquartile range [IQR]: 34-108) underwent MII-pH studies with median study duration of 22.41 hours (IQR: 21.5-23.32). A total of 4,070 hours of data were analyzed, with 8,480 reflux events (2,996 [35%] acidic, 5,484 [65%] nonacidic). A total of 2,541 symptoms were noted, 894 (35%) were temporally related to reflux events. A total of 113 infants (62.4%) had positive symptom association with SI > 50% and/or SAP > 95% for at least one symptom. There was modest symptom association for choking and gagging, but apnea, bradycardia, and desaturations had poor symptom association. Only 29 infants (16%) had pathological reflux, and only 18 infants (10%) had both pathological reflux and positive symptom association.
MII-pH can be used to characterize GERD in young infants, along with establishing temporal association with symptoms. Pathological reflux in symptomatic young infants is not common, but symptom association may occur without frequent or acidic reflux.
· Gastroesophageal reflux (GER) disease can be studied in young infants using MII-pH, to characterize the frequency and nature of GER events.. · The probability of GER events being associated temporally with GER symptoms can also be determined using MII-pH in this population.. · Using frequency of GER events, reflux indices, and symptom association indices with MII-pH, infants having true GER disease can be identified, thereby reducing unnecessary therapy.. · Symptom association may occur even without frequent or severe acidic reflux..
本研究旨在评估联合多通道腔内阻抗和pH值研究（MII-pH）在一大组有症状的小婴儿中的应用，以明确胃食管反流病（GERD）的发生情况，并使用症状指数确定反流行为与胃食管反流的时间关联。
这是一项对181例因临床行为提示GERD而接受MII-pH研究的婴儿进行的回顾性队列研究。症状指数（SI）和症状关联概率（SAP）用于确定症状与反流的关联。24小时内超过100次GER发作或酸反流指数>10%被视为病理性反流。
共有181例婴儿（中位年龄：60天，四分位间距[IQR]：34-108）接受了MII-pH研究，中位研究时长为22.41小时（IQR：21.5-23.32）。共分析了4070小时的数据，有8480次反流事件（2996次[35%]酸性，5484次[65%]非酸性）。共记录到2541个症状，其中894个（35%）与反流事件在时间上相关。共有113例婴儿（62.4%）至少有一个症状的SI>50%和/或SAP>95%，症状关联呈阳性。窒息和 gagging的症状关联程度一般，但呼吸暂停、心动过缓和血氧饱和度下降的症状关联较差。只有29例婴儿（16%）有病理性反流，只有18例婴儿（10%）既有病理性反流又有症状关联阳性。
MII-pH可用于明确小婴儿的GERD情况，并确定其与症状的时间关联。有症状的小婴儿病理性反流并不常见，但在没有频繁或酸性反流的情况下也可能出现症状关联。
·可使用MII-pH研究小婴儿的胃食管反流（GER）病，以明确GER事件的频率和性质。·在该人群中也可使用MII-pH确定GER事件与GER症状在时间上的关联概率。·利用MII-pH的GER事件频率、反流指数和症状关联指数，可识别真正患有GERD的婴儿，从而减少不必要的治疗。·即使没有频繁或严重的酸性反流，也可能出现症状关联。
