title: Impedance and extraesophageal manifestations of reflux in pediatrics.
abstract: OBJECTIVE
  Extraesophageal manifestations of gastroesophageal reflux (GER) include such signs and symptoms as cough, asthma, respiratory symptoms, hoarseness, and laryngoscopic findings. We reviewed the role of MII-pH monitoring in the evaluation of these findings in children to determine whether there is an association with pathological acid or nonacid reflux.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  We retrospectively reviewed charts from patients who underwent MII-pH. Inclusion criteria were ages 0 to 21 years with extraesophageal signs or symptom. Data were analyzed using dedicated software and manually reviewed. Reflux composite score was calculated based on DeMeester criteria. Impedance scores were calculated based on adult criteria. Symptom indexes were calculated.
  
  
  RESULTS
  A total of 119 MII-pH studies were performed. Of those, 63 studies met inclusion criteria. There were 39 males and 24 females with mean age 7.32 ± 4.1 years. The most common indication was cough. Six children had pathological GER based on DeMeester score. Using impedance criteria, only 10 of 63 patients had an abnormal evaluation (mean reflux episodes 107). Seven patients (15.2%) were found to have an association between symptom and reflux event.
  
  
  CONCLUSIONS
  No association was demonstrated between the extraesophageal signs and symptoms and pathological GER based on DeMeester score or the number of reflux events based on impedance testing.
authors.affiliation: Division of Gastroenterology and Nutrition, Cohen Children's Medical Center of New York, North Shore-Long Island Jewish Health System, New Hyde Park, New York, USA. mgreifer@nshs.edu
authors.forename: Melanie
authors.initials: M
authors.lastname: Greifer
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ng
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Levine
mesh_terms: D000367:Age Factors; D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D003371:Cough / Q000175:diagnosis / Q000453:epidemiology*; D003937:Diagnosis, Differential; D017097:Electric Impedance; D050782:Esophageal pH Monitoring; D005260:Female; D005744:Gastric Acid / Q000378:metabolism; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000453:epidemiology*; D006685:Hoarseness / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012852:Sinusitis / Q000175:diagnosis / Q000453:epidemiology