Outcomes of endoscopy and novel pH-impedance parameters in children: is there a correlation?
van der Pol, Rachel J
Loots, Clara M
Benninga, Marc Alexander
van Wijk, Michiel P
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Objectives: Discordance exists between outcomes of endoscopy, pH-metry, multichannel intraluminal impedance monitoring (pH-MII) and gastroesophageal reflux (GER) symptoms. MII baseline values have been suggested to be a marker for mucosal damage. Aim: To determine the association between endoscopy, pH-MII and MII baselines, in children with symptoms of GER. Methods: Patients who underwent endoscopy and pH-MII were studied retrospectively. Endoscopies were graded for reflux esophagitis (RE) according to the Los Angeles classification. Biopsies of the distal esophagus were assessed for signs suggestive of esophagitis. Reflux index (RI), symptom association probability (SAP), number of bolus reflux episodes and mean baseline values were calculated. Conventional pH-MII was considered positive in children when RI was ≥3% and/or SAP was ≥95% and for infants when RI was ≥10% and/or SAP was ≥95%. For the purpose of comparing MII baselines, patients were divided in three groups: 1. Normal endoscopy and negative overall pH-MII; 2. Normal endoscopy and an overall positive pH-MII result; and 3. RE. Results: 26 children and 14 infants were included, median age: 26.5 months (2 months-16.2 years). Thirteen (32.5%) children had RE. RE and histology suggestive of esophagitis did not correlate. A positive association was found for RI and MII baselines (p=.009) and between SAP and presence of RE (p=.039, OR=1.018). MII baseline values were not predictive for conventional pH-MII parameters nor for RE. Distal MII baselines were significantly lower in children and infants with a positive overall pH-MII outcome compared to the proximal esophagus (p=.049). No significant changes were found in baselines between the different groups 1-3. Conclusion: No significant associations of clinical relevance were found between endoscopy, conventional pH-MII parameters and pH-MII baseline values. Acid related parameters are significantly related to MII baselines. Large prospective studies are needed to confirm the exact role of endoscopy and MII baselines.
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