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Updated: Aug 19, 2026
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Gastroesophageal reflux disease in infants: how much is predictable with questionnaires, pH-metry, endoscopy and
Silvia Salvatore1, Bruno Hauser, Kris Vandemaele
1Clinica Pediatrica di Varese, Università dell'Insubria, Varese, Belgium.
Insights
Diagnosing gastroesophageal reflux disease (GERD) in infants is challenging, as clinical symptoms, pH studies, and histology show poor correlation. Questionnaires are unreliable for predicting GERD severity in infants.
Area of Science:
- Pediatric Gastroenterology
- Infant Health
- Diagnostic Accuracy
Background:
- Gastroesophageal reflux disease (GERD) symptoms are common in infants, making it difficult to distinguish between physiological and pathological reflux.
- Accurate diagnosis is crucial for appropriate infant evaluation and treatment.
Purpose of the Study:
- To determine the prevalence of reflux symptoms in infants.
- To assess the predictive value of a questionnaire for GERD.
- To evaluate the correlation between pH studies, histology, and clinical scores in infants.
Main Methods:
- Parents of 200 infants (100 well-baby clinic, 100 suspected GERD) completed a 35-item questionnaire, including the Orenstein I-GERQ score.
- Infants suspected of GERD underwent esophageal pH monitoring.
- 44 infants underwent upper gastrointestinal endoscopy with esophageal biopsy.
Main Results:
- Infants with suspected GERD reported more regurgitation (68% vs. 45%) and crying (51% vs. 20%) than healthy infants.
- Pathological pH studies (reflux index >10%) were found in 21% of infants, associated with pneumonia, apnea, constipation, and infrequent defecation.
- Esophagitis was present in 39% of infants, with significant discordance between pH studies and biopsies (32%). Questionnaires showed poor predictive value.
Conclusions:
- Clinical symptoms, histology, and pH studies demonstrate poor correlation in infant GERD diagnosis.
- Questionnaires are unreliable predictors of GERD severity, failing to correlate with esophageal acid exposure or esophagitis.
- Further research is needed to improve diagnostic accuracy for GERD in infants.
Unlabelled:
Symptoms of gastroesophageal reflux disease (GERD) are common in infants. It is often difficult to discriminate between physiological and pathologic gastroesophageal reflux, although this discrimination is essential to determine which infants to evaluate and treat.
Objectives:
To identify the prevalence of reflux symptoms in infants and to evaluate the predictive value of a questionnaire and the correlation between pH study, histology and clinical score.
Methods:
Parents of 100 unselected infants visiting the well-baby clinic and 100 infants suspected of having gastroesophageal reflux disease were asked to fill in a 35-item questionnaire. A validated score, the Orenstein I-GERQ, was applied for selected questions. All infants suspected of having gastroesophageal reflux disease underwent prolonged esophageal pH monitoring and 44 or 100 underwent upper gastrointestinal tract endoscopy with esophageal biopsy.
Results:
Parents of infants with suspected gastroesophageal reflux disease reported significantly more regurgitation (68% versus 45%, P < 0.05) and crying (51% versus 20%, P < 0.01) compared with the parents of healthy infants. A pathologic pH study (reflux index > 10%) was found in 21 of 100 (21%) infants and was significantly associated only with pneumonia, apnea with fussing (P = 0.013 for both), defecation less than once a day (P = 0.033) and constipation (P = 0.05). Esophagitis was present in 17 of 44 (39%) and no one question was found to be significantly predictive. 38% of infants with a pathologic pH study had a normal esophageal biopsy and 53% of infants with histologic esophagitis had a normal pH study. Discordance between pH study and biopsies occurred in 14 of 44 (32%) patients. The Orenstein I-GERQ cut-off score failed to identify eight of 31 (26%) infants with gastroesophageal reflux disease. Conversely, the score was positive in 17 of 22 (81%) infants with normal biopsy and pH study and in 14 of 47 (30%) infants with normal pH study.
Conclusions:
Clinical symptoms, histology and pH study show poor correlation in infants. Clinical symptoms such as regurgitation and crying are less frequent in unselected infants than in infants suspected of gastroesophageal reflux disease. However, questionnaires are poorly predictive for the severity of gastroesophageal reflux disease, as they do not correlate with esophageal acid exposure as measured by pH-metry and with esophagitis as evaluated by histology of esophageal biopsies.
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