Evaluation of gastroesophageal reflux events in children using multichannel intraluminal electrical impedance

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Abstract

The majority of gastroesophageal reflux (GER) episodes in infants and children are nonacidic (pH >4). However, extraesophageal symptoms (e.g., breathing irregularities, apnea, aspiration) apparently can be caused by both acidic (pH <4) and nonacidic reflux. The standard diagnostic tool for suspected GER is pH monitoring. However, physicians should be aware of the limitations of pH monitoring in the pediatric population, because most reflux episodes in this age group are undetectable by this method. In contrast, the pH-independent multiple intraluminal electrical impedance technique (IMP) allows all bolus movements in the esophagus to be detected. Data can be analyzed for bolus composition and reflux height, duration, and clearance. Combining IMP with pH monitoring on a single catheter has proved to be a valuable tool for diagnosing GER and associated symptoms in infants and children.

Section snippets

Technique

The multiple intraluminal electrical impedance technique (IMP) is a new method for the pH-independent detection of GER based on the registration of gastrointestinal motility.9, 10, 11, 12, 13 The principle of IMP is a change of electrical impedance during the passage of a bolus through a measuring segment (i.e., between 2 adjacent electrodes).14 The use of multiple segments along a catheter placed in the esophagus allows analysis of the direction of the bolus transport. Thus, anterograde and

Comparison of intraluminal impedance with pH monitoring

Combined intraesophageal IMP and pH monitoring were performed in 50 infants who were being evaluated for GER.16 Impedance tracings were analyzed for the unique pattern of retrograde bolus movement. Impedance values decrease in all channels reached by the refluxate. Change in impedance values begins in the distal channel and proceeds to more proximal channels, indicating a retrograde flow of gastric contents and representing an episode of GER. Software was developed to compare all parameters of

Gastroesophageal reflux detection and associated symptoms

Infants with a history of apnea, aspiration, or breathing irregularities were investigated simultaneously by combined intraesophageal IMP, pH monitoring, and overnight polysomnography.17 Polygraphic recording included, among other parameters, transcutaneous oxygen saturation (SO2), heart rate, oronasal flow, and chest wall movement. Documentation during each episode of GER included the minimal pH value, the maximal height reached by the refluxate in the esophagus, and the duration of GER (i.e.,

Conclusions

Numerous infants and children have been examined using IMP in Aachen, Germany. There have been no untoward side effects and only a few discontinuations due to technical reasons. Our results suggest that IMP for the registration and evaluation of GER provides important information that can supplement pH monitoring data in this population.19 This new method is especially useful in phases of gastric hypoacidity, which is common in the postprandial period, or during acid-suppressive therapy. By

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