Simultaneous monitoring of gastric and oesophageal pH reveals limitations of conventional oesophageal pH monitoring in milk fed infants.
BACKGROUND
Monitoring oesophageal pH conventionally detects "acid reflux" (pH less than 4). The pH of the gastric contents determines whether or not reflux can be detected.


OBJECTIVE
To monitor gastric and oesophageal pH simultaneously in order to determine the effect of milk feeds on gastric pH and how this would influence interpretation of the oesophageal pH record.


METHODS
Milk fed infants for whom oesophageal pH monitoring was requested underwent simultaneous gastric and oesophageal pH monitoring using a dual channel pH probe.


RESULTS
Twenty of 24 records were technically satisfactory. Mean reflux index was 1.0%, range 0.0-4.0%. Gastric pH was less than 4 for 24.5% (range 0.6-69.1%) of the total time. The average time the gastric pH was greater than 4 after feeds was 130 minutes (range 29-212 minutes). The corrected reflux index (limited to the time the gastric pH was less than 4) was 2.6% (range 0.0-11.0%).


CONCLUSIONS
The pH of the gastric contents may be greater than 4 for prolonged intervals, during which oesophageal pH monitoring using current criteria cannot detect reflux nor correlate it with clinical events. A low reflux index may reflect prolonged buffering of gastric acidity rather than the absence of reflux.
Mitchell
D J
DJ
The Nuffield Department of Child Health, The Queen's University of Belfast, Institute of Clinical Science, Grosvenor Road, Belfast BT12 6BJ, UK. davidmitchell@doctors.org.uk
McClure
B G
BG
Tubman
T R
TR
D000818:Animals; D004947:Esophagus / Q000737:chemistry*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D007225:Infant Food; D007231:Infant, Newborn; D008297:Male; D008892:Milk; D011237:Predictive Value of Tests; D013270:Stomach / Q000737:chemistry*; D013997:Time Factors