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[Simultaneous recording of pH in the distal and proximal esophagus]
L Pradeaux1, J B Gouyon, V Boggio
1Service de Pédiatrie 2, Hôpital d'Enfants, Dijon.
Insights
Gastroesophageal reflux (GER) in infants shows poor correlation between upper and lower esophagus measurements. Weakly acid reflux is more common in the upper esophagus than acid reflux.
Area of Science:
- Pediatric Gastroenterology
- Esophageal pH Monitoring
- Infant Reflux
Context:
- Gastroesophageal reflux (GER) is common in infants, but its upper esophageal manifestation is not well understood.
- Simultaneous pH monitoring in proximal and distal esophagus is crucial for accurate GER assessment.
Purpose:
- To investigate the correlation between proximal and distal esophageal gastroesophageal reflux (GER) in infants.
- To determine the predictive value of distal esophageal GER measurements for proximal esophageal events.
Summary:
- A 24-hour esophageal pH study in 46 infants revealed significant correlations for acid and weakly acid GER, reflux index, and prolonged acid reflux events.
- However, proximal esophageal acid GER and time spent at pH < 4 were significantly higher in infants with distal reflux index > 5%.
- Distal GER measurements poorly predict proximal events, with weakly acid reflux reaching the upper esophagus more frequently than acid reflux.
Impact:
- Findings highlight the limitations of relying solely on distal esophageal data for diagnosing infant GER.
- Emphasizes the need for proximal esophageal monitoring to fully characterize GER in infants.
- Provides insights into the distinct behavior of acid versus weakly acid reflux in the infant esophagus.
Abstract:
A 24 hour esophageal pH recording was performed in 46 infants (age: 10 +/- 12 months). Two probes were placed in the proximal and distal esophageal sites respectively. A significant correlation was shown between the upper and lower part of the esophagus for the numbers of acid (pH fall below 4 for at least 15 s) and weakly acid (fall in pH of more than one unit, irrespective of whether or not the pH fell below 4) gastroesophageal reflux (GER), the reflux index and the number of acid GER longer than 5 min. The number of acid GER and the time spent at pH less than 4 at the proximal esophagus were significantly greated in group 1 (reflux index greater than 5% in the distal esophagus, n = 10), than in group 2 (reflux index less than 5% in the distal esophagus, n = 36). The proportion of distal acid and weakly acid reflux reaching the upper esophagus presented with marked variation coefficients. These findings indicate that data obtained in the distal esophagus are poorly predictive of the results in the proximal esophagus, even if infants present high reflux index at the lower esophagus. Weakly acid GER reached the upper esophagus more frequently than acid GER.