title: Does reflux monitoring with multichannel intraluminal impedance change clinical decision making?
abstract: OBJECTIVE
  Multichannel intraluminal impedance with pH (pH-MII) has become the criterion standard test for the evaluation of gastroesophageal reflux disease, but it is not clear whether the results of this test change clinical decision making. The goal of the present study was to determine the differences in clinical decision making by attending physicians based on the pH probe results versus MII results.
  
  
  METHODS
  We conducted a prospective study in which physicians were initially given pH probe results and asked how they would change the patient's clinical management based on these results. Physicians were then given the MII results and asked how their management would change. Physicians then were asked whether they believed MII affected their clinical decision making overall.
  
  
  RESULTS
  pH probe results changed clinical management 40% of the time and MII results changed clinical management an additional 22% of the time. Clinical decision making was not influenced by the performance of pH-MII on or off acid suppression. The escalation of acid suppression therapy was the main management change that occurred based on the pH-MII results.
  
  
  CONCLUSIONS
  The addition of MII to the standard pH probe resulted in a change in management in approximately 25% of the patients, suggesting that there may be a role for pH-MII in clinical practice.
authors.affiliation: Center for Motility and Functional Gastrointestinal Disorders, Children's Hospital Boston, Boston, MA 02115, USA. rachel.rosen@childrens.harvard.edu
authors.forename: Rachel
authors.initials: R
authors.lastname: Rosen
authors.forename: Kristen
authors.initials: K
authors.lastname: Hart
authors.forename: Samuel
authors.initials: S
authors.lastname: Nurko
mesh_terms: D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D003938:Diagnostic Techniques, Digestive System / Q000295:instrumentation*; D017097:Electric Impedance; D055664:Electrochemical Techniques; D050782:Esophageal pH Monitoring / Q000295:instrumentation; D004947:Esophagus; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000188:drug therapy* / Q000628:therapy; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006776:Hospitals, Pediatric; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D008297:Male; D008505:Medical Staff, Hospital; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies
chemical_list: D005765:Gastrointestinal Agents