title: Clinical value of wireless pH-monitoring of gastro-esophageal reflux in children before and after proton pump inhibitors.
abstract: BACKGROUND
  Wireless pH-monitoring is an accurate method for diagnosing adults with gastroesophageal reflux disease (GERD). The aim of this study was to evaluate the use of the Bravo capsule on children investigated for GERD in terms of safety, tolerability and feasibility before and after administration of proton pump inhibitors.
  
  
  METHODS
  A Bravo capsule was inserted during upper endoscopy under general anaesthesia or deep sedation with propofol. 48-hour pH-metry was performed in 106 children (50 males, 56 females) at the median age of 11 years (range 17 months-18 years). On the second day of investigation, proton pump inhibitor (PPI) was given at a mean dose of 1.6 mg/kg (SD ±0.6 mg). The definition of GERD was set to a reflux index (RI) of ≥5% and DeMeester score (DMS) ≥14.7.
  
  
  RESULTS
  Application of the capsule was successful in 103 of the 106 children (97.2%) and interpretable in 99 of these 103 (96.1%). 49 of the children with interpretable results (49.5%) had GERD according to RI, while 51 (56.7%) had GERD according to DMS. After PPI was given on day 2, RI decreased from a median of 4.9% (range 0.3-63.4%) to 2.2% (0-58.0%), while DMS decreased from a median of 17.6 (range 2.2-207.6) to 8.2 (0.3-178.6), respectively (p < 0.0001). No severe adverse events were reported.
  
  
  CONCLUSIONS
  Wireless pH-metry is a safe and tolerable method when investigating children for GERD. PPI given on the second day of assessment provides additional information on response to treatment suggesting that pH-metry preferably should be extended to 48 hours.
authors.affiliation: Department of Pediatrics, Unit of Endocrinology and Gastroenterology, Skåne University Hospital, Malmö, Sweden. michaela.bostrom@gmail.com.
authors.forename: Michaela
authors.initials: M
authors.lastname: Boström
authors.affiliation: Department of Clinical Physiology, Skåne University Hospital, Malmö, Sweden. ola.thorsson@skane.se.
authors.forename: Ola
authors.initials: O
authors.lastname: Thorsson
authors.affiliation: Department of Gastroenterology, Endoscopy Unit, Skåne University Hospital, Malmö, Sweden. ervin.toth@med.lu.se.
authors.forename: Ervin
authors.initials: E
authors.lastname: Toth
authors.affiliation: Department of Pediatrics, Unit of Endocrinology and Gastroenterology, Skåne University Hospital, Malmö, Sweden. daniel.agardh@med.lu.se.
authors.forename: Daniel
authors.initials: D
authors.lastname: Agardh
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016145:Endoscopy, Digestive System; D050782:Esophageal pH Monitoring / Q000009:adverse effects / Q000295:instrumentation; D005240:Feasibility Studies; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007223:Infant; D008297:Male; D008904:Miniaturization; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D054328:Proton Pump Inhibitors