title: Pre and post-operative evaluation of gastroesophageal reflux and esophageal motility in neurologically impaired children using combined pH-multichannel intraluminal impedance measurements.
abstract: BACKGROUND
  Gastroesophageal reflux disease (GERD) in patients with neurological impairment (NI) has not been fully studied before and after fundoplication procedure because their characteristics such as generalized gastrointestinal dysmotility, non-acid reflux, and the proximal reflux due to feeding of enteral nutrition via a nasogastric tube prevent their GERD from being detected by 24 h pH monitoring. The aim of this study was to elucidate whether multichannel impedance-pH measurement (pH/MII) is able to detect the subtypes of GERD and the differences in the reflux episodes of the severity of GERD, the ingestion pathway, and before and after fundoplication. The second aim was to determine whether a trial evaluation of dry swallows was able to be used to assess the esophageal motility of NI patients as an alternative examination.
  
  
  METHODS
  The 24 h pH/MII was conducted on 20 NI children [15 were the patients before Nissen's fundoplication (BN), of whom, six were fed orally (FO) and nine were fed via nasogastric tube (NGT), and five were the patients after Nissen's fundoplication (AN)]. All reflux episodes were evaluated and compared between patients with pathological GERD (PG) and non-pathological GERD (NG) and between patients who had FO and NGT and patients between BN and AN. Dry swallows were conducted to evaluate the esophageal motility. The average bolus presence time (BPT) and total bolus transit time (TBTT) were compared between the PG and NG, FO and NGT, and the BN and AN subgroups.
  
  
  RESULTS
  A total of 1,064 reflux episodes were detected by pH/MII. Of those, 303 (28.5 %) were non-acid-related and 477 episodes reached the proximal esophagus. Of the 12 patients (57.1 %) showing pathological GERD, two cases (16.7 %) demonstrated predominantly weakly acidic PG. More than half of the reflux episodes of PG patients reached to the proximal esophagus. The numbers of total reflux and proximal reflux episodes in the PG were significantly higher than those in NG patients. The number of proximal reflux episodes in the FO group was significantly higher than that in the NGT groups, whereas NGT patients showed more non-acidic reflux episodes than FO patients. A trial evaluation of dry swallows demonstrated no significant differences in this study.
  
  
  CONCLUSIONS
  The pH/MII was useful to detect the subtype of GERD in NI patients which could not be detected by 24 h pH monitoring. It can, therefore, be considered to have first priority for testing NI patients who are suspected to be suffering from GERD.
authors.affiliation: Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan. s_fukahori@med.kurume-u.ac.jp
authors.forename: Suguru
authors.initials: S
authors.lastname: Fukahori
authors.forename: Kimio
authors.initials: K
authors.lastname: Asagiri
authors.forename: Shinji
authors.initials: S
authors.lastname: Ishii
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Shin-Ichiro
authors.initials: S
authors.lastname: Kojima
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Saikusa
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Koga
authors.forename: Motomu
authors.initials: M
authors.lastname: Yoshida
authors.forename: Daisuke
authors.initials: D
authors.lastname: Masui
authors.forename: Naoko
authors.initials: N
authors.lastname: Komatsuzaki
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Seki
authors.forename: Minoru
authors.initials: M
authors.lastname: Yagi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017097:Electric Impedance; D050782:Esophageal pH Monitoring; D004947:Esophagus / Q000378:metabolism / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000378:metabolism / Q000601:surgery; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D008297:Male; D008365:Manometry / Q000379:methods; D009422:Nervous System Diseases / Q000150:complications* / Q000503:physiopathology; D011184:Postoperative Period; D057234:Preoperative Period; D055815:Young Adult