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Comparison of methods of assessing 24-hour intraesophageal pH recordings in children
C A Friesen1, R Hayes, C Hodge
1Section of Gastroenterology, Children's Mercy Hospital, Kansas City, Missouri 64108.
Insights
Different scoring methods for intraesophageal pH monitoring in infants yield varied results. The early and late postprandial methods better identify gastroesophageal reflux (GER)-induced events than total recording, highlighting the need for standardized infant GER evaluation.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Testing
- Infant Health
Background:
- Prolonged intraesophageal pH recording is crucial for diagnosing gastroesophageal reflux (GER) disease in children.
- Current methodologies for performing and evaluating these tests vary significantly.
Purpose of the Study:
- To compare three different scoring methods for 24-hour intraesophageal pH recordings in infants.
- To assess the ability of these methods to identify infants with GER-induced acute life-threatening events (ALTEs).
Main Methods:
- Evaluated 24-hour intraesophageal pH recordings from 67 infants using early postprandial, late postprandial, and total recording scoring methods.
- Correlated scoring methods with clinically defined GER-induced ALTEs in 20 infants.
Main Results:
- Significant positive correlations existed between all pairs of scoring systems.
- Methods identified different patient groups, with early/late postprandial disagreeing with normal/abnormal status in ~20% of cases.
- Early and late postprandial methods identified 90-95% of GER-induced ALTEs, while total recording identified only 45%.
Conclusions:
- The three scoring methods for infant intraesophageal pH monitoring show imperfect correlation.
- The total recording method is less sensitive in identifying GER-induced ALTEs compared to postprandial methods.
- Standardization of intraesophageal pH monitoring in infants is recommended to improve diagnostic consistency and clinical significance.
Abstract:
Prolonged intraesophageal pH recording, an important test in the evaluation of children with suspected gastroesophageal reflux (GER) disease, may be performed and evaluated by markedly different methodologies. Twenty-four-hour intraesophageal pH recordings from 67 consecutive infants were evaluated by three scoring methods: early postprandial, late postprandial, and total recording. In addition, the scoring methods were evaluated for their ability to identify 20 infants with clinically defined GER-induced acute life-threatening events (ALTEs). There were significant positive correlations between each pair of scoring systems (early postprandial with late postprandial, early postprandial with total recording, and late postprandial with total recording). However, our data indicate that the three methods identify different groups of patients. The early and late postprandial methods disagreed in designating "normal" versus "abnormal" in approximately 20% of patients. The total recording method was more likely to label patients as normal than either of the other methods; it yielded normal results in approximately one half of patients abnormal by either the early or the late postprandial methods. Patients with GER-induced ALTEs were identified by the early postprandial method in 90% of cases, the late postprandial method in 95% of cases, and the total recording method in only 45% of cases. By applying three different scoring methods to the same 24-h intraesophageal pH recording, we demonstrated less-than-perfect correlation among the methods. Long-term follow-up is needed to determine if these differences are of clinical significance. We feel that effort should be directed toward standardizing the approach to intraesophageal pH monitoring in infants.