title: Utility of pH/multichannel intraluminal impedance probe in identifying operative patients in infants with gastroesophageal reflux disease.
abstract: BACKGROUND
  Gastroesophageal reflux is a common clinical problem in infants, but identifying which infants may benefit from a fundoplication remains a conundrum. Esophageal pH and multichannel intraluminal impedance (MII) measurements are useful diagnostic tools in adults and older children, but their diagnostic efficacy in infants is unclear. Therefore, we reviewed our experience with the combined pH/MII probe in this population.
  
  
  METHODS
  A retrospective review of patients ≤ 6 months of age who were studied with the pH/MII probe from 2006 to 2010 was performed. Test results, interventions, and outcomes were reviewed. Patients were divided into operative and nonoperative groups, and pH probe and MII results were compared.
  
  
  RESULTS
  Fifty-seven patients (53% male) were identified. Mean age at the time of pH/MII probe was 3.1 months. Regarding the operative group (n = 33), 21% had an abnormal pH probe, and 100% had an abnormal MII; 97% had symptom improvement at a mean follow-up of 16 months (range, 0.4-38 months). In the nonoperative group (n = 24), 29% had an abnormal pH probe, and 100% had an abnormal MII. There was no significant difference in reflux index, Boix-Ochoa score, or percentage of acid and non-acid reflux between the two groups.
  
  
  CONCLUSIONS
  The pH and MII studies are poor indicators of pathologic reflux in infants and do not adequately discern which patients will benefit from fundoplication.
authors.affiliation: The Children's Mercy Hospital, Kansas City, Missouri, 64108, USA.
authors.forename: Frankie B
authors.initials: FB
authors.lastname: Fike
authors.forename: Janine N
authors.initials: JN
authors.lastname: Pettiford
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
authors.forename: Jose
authors.initials: J
authors.lastname: Cocjin
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Laituri
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ostlie
mesh_terms: D003938:Diagnostic Techniques, Digestive System; D017097:Electric Impedance; D050782:Esophageal pH Monitoring; D004947:Esophagus / Q000503:physiopathology; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies