title: Combined multichannel intraluminal impedance and pH monitoring assists the diagnosis of sliding hiatal hernia in children with gastroesophageal reflux disease.
abstract: BACKGROUND
  The role of combined multichannel intraluminal impedance and pH monitoring (MII-pH) in diagnosing sliding hiatal hernia in gastroesophageal reflux disease (GERD) children remains unclear. We aimed to explore the clinical efficacy of MII-pH as a supplement diagnostic method for sliding hiatal hernia.
  
  
  METHODS
  A total of 104 symptomatic GERD children [mean ± standard deviation (SD) age = 4.5 ± 5.5 years] were recruited. All of them were diagnosed as GERD with and without sliding hiatal hernia by barium and/or esophagogastroduodenoscopy study. All subjects received 24 h MII-pH monitoring to test the efficacy of this new modality.
  
  
  RESULTS
  Sixteen children were diagnosed to have sliding hiatal hernia, and nine (56.3%) of them received fundoplication. None of non-hiatal hernia children were indicated for fundoplication [risk difference (RD) 0.56; P < 0.001]. Impedance probes detected more reflux episodes than pH-probe in the whole study population (mean ± SD = 62.1 ± 47.8 vs. 47.8 ± 48.1 episodes; P = 0.02, paired t test). Due to the presence of pH-only reflux, the reflux episodes detected by impedance probes is less than that by pH probe in sliding hiatal hernia children (mean ± SD = 49.2 ± 78.9 vs. 103.7 ± 60.4 episodes; P = 0.01, paired t test). Ratio of reflux episodes detected by pH-probe to that by impedance probes >1 was more frequently noted in sliding hiatal hernia children than non-sliding hiatal hernia children (Odds ratio 58.33, P < 0.001). The sensitivity and specificity of this diagnostic tool to predict sliding hiatal hernia in GERD children are 93.8 and 79.6%, respectively.
  
  
  CONCLUSIONS
  Ratio of reflux episodes detected by pH-probe to that by impedance probes >1 demonstrated by MII-pH study is a good screening test of sliding hiatal hernia in GERD children.
authors: Department of Pediatrics, National Taiwan University Children's Hospital and College of Medicine, National Taiwan University, No. 8, Chung Shan South Road, Taipei, 100, Taiwan.
authors: Jia-Feng
authors: JF
authors: Wu
authors: Wei-Chung
authors: WC
authors: Hsu
authors: Ping-Huei
authors: PH
authors: Tseng
authors: Hsiu-Po
authors: HP
authors: Wang
authors: Hong-Yuan
authors: HY
authors: Hsu
authors: Mei-Hwei
authors: MH
authors: Chang
authors: Yen-Hsuan
authors: YH
authors: Ni
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017097:Electric Impedance; D050782:Esophageal pH Monitoring; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D006551:Hernia, Hiatal / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted
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