title: Addition of pH-impedance monitoring to standard pH monitoring increases the yield of symptom association analysis in infants and children with gastroesophageal reflux.
abstract: OBJECTIVE
  To assess the additional yield of combined multichannel intraluminal pH-impedance (pH-MII) monitoring compared with standard pH monitoring on gastroesophageal reflux (GER) symptom associations in infants and children.
  
  
  METHODS
  In 80 patients, 24-hour ambulatory pH-MII monitoring was performed. Tracings were analyzed with established pH-MII criteria. Symptoms of regurgitation and belching were excluded from analysis, because these were considered to be a direct consequence of GER. Standard GER-symptom correlation indices were calculated with: 1) standard pH monitoring; 2) MII detection of liquid and mixed bolus GER; 3) MII detection of all bolus GER (liquid, mixed, and gas); 4) pH-MII detection of all GER, including pH-only GER.
  
  
  RESULTS
  Fifty patients (21 children) were included. MII detection of all bolus GER yielded a significantly greater number of patients who were symptom-positive, 36 (72%) compared with 25 (50%) with standard pH-monitoring (P = .04). A positive symptom association was observed in 8 of 10 (80%) patients with pathological esophageal acid exposure and 28 of 40 (70%) patients with negative pH-findings.
  
  
  CONCLUSIONS
  A high proportion of patients with normal esophageal acid exposure had a positive symptom association on pH-MII monitoring. Including all MII-detected bolus GER and excluding pH-only GER for analysis optimizes the yield of GER-symptom associations in infants and children.
authors.affiliation: Academic Medical Centre, Amsterdam, The Netherlands. c.m.loots@amc.uva.nl
authors.forename: Clara M
authors.initials: CM
authors.lastname: Loots
authors.forename: Marc A
authors.initials: MA
authors.lastname: Benninga
authors.forename: Geoffrey P
authors.initials: GP
authors.lastname: Davidson
authors.forename: Taher I
authors.initials: TI
authors.lastname: Omari
mesh_terms: D002675:Child, Preschool; D017097:Electric Impedance; D050782:Esophageal pH Monitoring; D004947:Esophagus / Q000503:physiopathology*; D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000503:physiopathology*; D006801:Humans; D007223:Infant