title: Reflux events detected by pH-MII do not determine fundoplication outcome.
abstract: BACKGROUND
  Because of complications and its invasive nature, fundoplication is often a treatment of last resort for children with gastroesophageal reflux. Gastroesophageal reflux testing does not always predict who will benefit from antireflux surgery. Furthermore, there are no studies to determine whether a higher preoperative reflux burden, including acid and nonacid reflux, is associated with an improved postfundoplication outcome. The aim of the study was to determine predictors of fundoplication outcome including acid and nonacid reflux burden.
  
  
  METHODS
  We retrospectively reviewed preoperative pH-multichannel intraluminal impedance tracings and medical records of 34 patients who underwent fundoplication. Patients were categorized as improved or not improved, and the demographic and reflux characteristics were compared between groups. Multivariate analysis was performed to determine predictors of outcome.
  
  
  RESULTS
  No single reflux marker, including the number of acid, nonacid, total events, or the percentage of time that reflux was in the esophagus, predicted fundoplication outcome (P > 0.1). Neither a positive symptom index nor a positive symptom sensitivity index predicted postoperative improvement (P > 0.4). Receiver operating characteristic curve analysis failed to reveal an ideal value to maximize sensitivity for either the symptom index or the symptom sensitivity index.
  
  
  CONCLUSIONS
  pH-multichannel intraluminal impedance testing may not be a useful tool in predicting fundoplication outcome.
authors.affiliation: Center for Motility and Functional Gastrointestinal Disorders, Children's Hospital Boston, Boston, Massachusetts 02115, USA. Rachel.rosen@childrens.harvard.edu
authors.forename: Rachel
authors.initials: R
authors.lastname: Rosen
authors.forename: Phillip
authors.initials: P
authors.lastname: Levine
authors.forename: Jessica
authors.initials: J
authors.lastname: Lewis
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
authors.forename: Samuel
authors.initials: S
authors.lastname: Nurko
mesh_terms: D002648:Child; D017097:Electric Impedance; D050782:Esophageal pH Monitoring; D004947:Esophagus / Q000503:physiopathology / Q000601:surgery*; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000379:methods; D012372:ROC Curve; D012016:Reference Values; D012189:Retrospective Studies; D012720:Severity of Illness Index