title: Influence of percutaneous endoscopic gastrostomy on gastro-oesophageal reflux evaluated by multiple intraluminal impedance in children with neurological impairment.
abstract: OBJECTIVE
  The aim of the study was to estimate the influence of percutaneous endoscopic gastrostomy (PEG) placement on gastro-oesophageal reflux (GOR) by using multiple intraluminal impedance (MII/pH) measurements in children with neurological impairments.
  
  
  METHODS
  Fifteen children with neurological impairments (cerebral palsy, n=10; cerebroidolipofuscinosis, n=2; Aicardi syndrome, n=1; and secondary encephalopathy, n=2) were investigated (interquartile range [IQR] 6y 4mo-14y 8mo; median age 10y 2mo; eight male, seven female). Individuals with nutritional disorders that could not be corrected by physiological means or with swallowing disorders that either caused chronic respiratory symptoms or prevented food intake were included in the study. The exclusion criteria included previous major abdominal surgery and a lack of consent for PEG. Participants underwent MII/pH for a 24-hour period and had an oesophagogastroduodenoscopy before PEG placement, which was repeated 6 to 8 months later.
  
  
  RESULTS
  At baseline, GOR was detected in 6 of the 15 participants, and the second MII/pH session revealed GOR in 2 of the 15 children. Differences between quantitative GOR indices obtained before and after PEG were not statistically significant, except for the proportion of the acidic/weakly acidic reflux events - among all participants in the first examination, 159 reflux episodes were acidic and 244 were weakly acidic, while in the follow-up recordings the proportion was inverted (244 acidic, 136 weakly acidic; χ(2) =47.0; p<0.001). Baseline endoscopy did not reveal any macroscopic changes in any of the examined individuals, but the follow-up examination revealed oesophagitis in two participants. The median body weight gain after 6 months as 22.0% (IQR 14.4-29.2%). All participants tolerated PEG feeding well, regardless of MII/pH results.
  
  
  CONCLUSIONS
  Identification of GOR based on MII/pH in children with neurological impairments does not exclude a good clinical response to PEG feeding.
authors.affiliation: Department of Pediatric Allergology, Gastroenterology and Nutrition, Medical University of Lodz, Lodz, Poland. etka@op.pl
authors.forename: Ewa
authors.initials: E
authors.lastname: Toporowska-Kowalska
authors.forename: Beata
authors.initials: B
authors.lastname: Gębora-Kowalska
authors.forename: Janusz
authors.initials: J
authors.lastname: Jabłoński
authors.forename: Wojciech
authors.initials: W
authors.lastname: Fendler
authors.forename: Krystyna
authors.initials: K
authors.lastname: Wąsowska-Królikowska
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017097:Electric Impedance; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000209:etiology*; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000150:complications / Q000601:surgery; D018709:Statistics, Nonparametric