title: Comparison of multichannel intraluminal impedance-pH monitoring and reflux scintigraphy in pediatric patients with suspected gastroesophageal reflux.
abstract: OBJECTIVE
  To evaluate the agreement of multichannel intraluminal impedance-pH monitoring (MII-pHM) and gastroesophageal reflux scintigraphy (GES) for the diagnosis of gastroesophageal reflux disease.
  
  
  METHODS
  Seventy-five consecutive patients with suspected gastroesophageal reflux disease (GERD) underwent 24-h combined MII-pHM recording and one hour radionuclide scintigraphy during the course of the MII-pHM study. Catheters with 6 impedance channels and 1 pH sensor were placed transnasally. Impedance and pH data analysis were performed automatically and manually. For impedance monitoring, reflux was defined as a retrograde 50% drop in impedance, starting distally and propagating retrogradely to at least the next two more proximal measuring channels. Reflux index (RI, percentage of the entire record that esophageal pH is < 4.0) greater than 4.2% for pHM and number of refluxes more than 50 for 24 h for MII were accepted as positive test results. At scintigraphy, 240 frames of 15 seconds duration were acquired in the supine position. Gastroesophageal reflux was defined as at least one reflux episode in the esophagus. After scintigraphic evaluation, impedance-pH recordings and scintigraphic images were evaluated together and agreement between tests were evaluated with Cohen's kappa.
  
  
  RESULTS
  Sufficient data was obtained from 60 (80%) patients (34 male, 56.7%) with a mean age of 8.7 ± 3.7 years (range: 2.5-17.3 years; median: 8.5 years). Chronic cough, nausea, regurgitation and vomiting were the most frequent symptoms. The mean time for recording of MII-pHM was 22.8 ± 2.4 h (range: 16-30 h; median: 22.7 h). At least one test was positive in 57 (95%) patients. According to diagnostic criteria, GERD was diagnosed in 34 (57.7%), 44 (73.3%), 47 (78.3%) and 51 (85%) patients by means of pHM, MII, GES and MII-pHM, respectively. The observed percentage agreements/κ values for GES and pHM, GES and MII, GES and MII-pHM, and MII and pHM are 48.3%/-0.118; 61.7%/-0.042; 73.3%/0.116 and 60%/0.147, respectively. There was no or slight agreement between GES and pHM alone, MII alone or MII-pHM. pH monitoring alone missed 17 patients compared to combined MII-pHM. The addition of MII to pH monitoring increased the diagnosis rate by 50%.
  
  
  CONCLUSIONS
  No or slight agreement was found among pH monitoring, MII monitoring, MII-pH monitoring and GES for the diagnosis of gastroesophageal reflux disease.
authors.affiliation: Nuray Uslu Kızılkan, Division of Pediatric Gastroenterology, Koc University Hospital, Topkapı, Istanbul 34010, Turkey.
authors.forename: Nuray
authors.initials: N
authors.lastname: Uslu Kızılkan
authors.affiliation: Nuray Uslu Kızılkan, Division of Pediatric Gastroenterology, Koc University Hospital, Topkapı, Istanbul 34010, Turkey.
authors.forename: Murat Fani
authors.initials: MF
authors.lastname: Bozkurt
authors.affiliation: Nuray Uslu Kızılkan, Division of Pediatric Gastroenterology, Koc University Hospital, Topkapı, Istanbul 34010, Turkey.
authors.forename: Inci Nur
authors.initials: IN
authors.lastname: Saltık Temizel
authors.affiliation: Nuray Uslu Kızılkan, Division of Pediatric Gastroenterology, Koc University Hospital, Topkapı, Istanbul 34010, Turkey.
authors.forename: Hülya
authors.initials: H
authors.lastname: Demir
authors.affiliation: Nuray Uslu Kızılkan, Division of Pediatric Gastroenterology, Koc University Hospital, Topkapı, Istanbul 34010, Turkey.
authors.forename: Aysel
authors.initials: A
authors.lastname: Yüce
authors.affiliation: Nuray Uslu Kızılkan, Division of Pediatric Gastroenterology, Koc University Hospital, Topkapı, Istanbul 34010, Turkey.
authors.forename: Biray
authors.initials: B
authors.lastname: Caner
authors.affiliation: Nuray Uslu Kızılkan, Division of Pediatric Gastroenterology, Koc University Hospital, Topkapı, Istanbul 34010, Turkey.
authors.forename: Hasan
authors.initials: H
authors.lastname: Özen
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D017097:Electric Impedance; D050782:Esophageal pH Monitoring / Q000379:methods*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D056888:Patient Positioning; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging / Q000379:methods*; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D016683:Supine Position; D013997:Time Factors
chemical_list: D019275:Radiopharmaceuticals
keywords: Children; Esophageal pH monitoring; Gastroesophageal reflux disease; Multichannel intraluminal impedance; Scintigraphy