title: Esophagitis in distressed infants: poor diagnostic agreement between esophageal pH monitoring and histopathologic findings.
abstract: OBJECTIVE
  Our purpose was to study the relation between gastroesophageal reflux (GER) and esophagitis in infants with persistent distress.
  
  
  METHODS
  Infants (n = 125, 79 boys; median age, 4.2 months) with persistent distress and clinical symptoms suggestive of GER and esophagitis were retrospectively studied. All had undergone esophageal 24-hour pH monitoring and had upper gastrointestinal biopsy specimens taken.
  
  
  RESULTS
  There were 65 (48%) infants with inflammatory changes found in at least one upper gastrointestinal biopsy specimen, of whom 32 (25.6%) had esophagitis; 11 infants with esophagitis also had gastritis or duodenitis. Although infants with frequent regurgitation (n = 65) had significantly more frequent GER episodes per 24 hours (P <.03) and greater fractional reflux time (P <.001) than infants without, this was not associated with histologic esophagitis (P =.33). Of the 32 infants with esophagitis, 9 had abnormal pH monitoring and 23 had nonreflux esophagitis. A separate group of 23 infants had abnormal pH monitoring but no esophagitis. Diagnostic agreement between pH monitoring and esophageal histologic features was poor (kappa = 0.07).
  
  
  CONCLUSIONS
  Esophagitis occurred in one quarter of infants with persistent distress. Abnormal esophageal pH monitoring did not reliably predict esophagitis, suggesting a nonacid peptic cause in some of these infants.
authors.affiliation: Department of Gastroenterology, Royal Children's Hospital, Melbourne, Australia.
authors.forename: Ralf G
authors.initials: RG
authors.lastname: Heine
authors.forename: Donald J s
authors.initials: DJ
authors.lastname: Cameron
authors.forename: Chung W
authors.initials: CW
authors.lastname: Chow
authors.forename: David J
authors.initials: DJ
authors.lastname: Hill
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Catto-Smith
mesh_terms: D004941:Esophagitis / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D004947:Esophagus / Q000378:metabolism; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008991:Monitoring, Physiologic; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies