Indications, methodology, and interpretation of combined esophageal impedance-pH monitoring in children: ESPGHAN EURO-PIG standard protocol.
OBJECTIVE
The aim of the study was to provide an updated position statement from the ESPGHAN European Pediatric Impedance Working Group on different technical aspects such as indications, methodology, and interpretation of multichannel intraluminal impedance-pH monitoring (MII-pH).


METHODS
Evidence was used where available, but the article is based mainly on expert opinion and consensus.


RESULTS
MII-pH provides more information than simple pH monitoring because reflux detection is not limited to acid reflux. Different companies provide commercialized MII-pH recording systems, making the method widely available and useable in daily clinical practice; however, the technique still has limitations: high cost, limited additional value regarding therapeutic implications, and lack of evidence-based parameters for the assessment of gastroesophageal reflux and symptom association in children.


CONCLUSIONS
MII-pH recording is a promising procedure needing further validation and development to increase its additional benefit over conventional investigation techniques. The added value of the technique regards mainly clinical circumstances in which nonacid or weakly acid reflux may be relevant such as persisting symptoms during antireflux treatment with proton pump inhibitors and feeding-related reflux; and assessing specific discontinuous symptoms thought to be associated with gastroesophageal reflux; and research.
Klinik für Kinder und Jugendmedizin, Universitätsklinikum der RWTH Aachen, Aachen, Germany. twenzl@ukaachen.de
Tobias G
TG
Wenzl
Marc A
MA
Benninga
Clara M
CM
Loots
Silvia
S
Salvatore
Yvan
Y
Vandenplas
D002648:Child; D050782:Esophageal pH Monitoring; D004947:Esophagus; D005060:Europe; D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000175:diagnosis*; D006801:Humans; D012955:Societies, Medical