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[Intraluminal impedance technique in the diagnosis of apparent life-threatening events (ALTE)]
R Granero Cendón1, M J Moya Jiménez, J A Cabo Valdés
1Unidad de Motilidad Intestinal, Hospital Infantil Universitario Virgen del Rocío, Sevilla.
Insights
Intraluminal impedance effectively diagnoses gastroesophageal reflux in infants with apparent life-threatening events (ALTE), differentiating acid and non-acid reflux. This method reveals reflux rates similar to healthy infants, with a significant link to apnea in only one case.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Technology
- Infant Health
Context:
- Apparent life-threatening events (ALTE) in infants are often linked to underlying pathologies.
- Gastroesophageal reflux is a significant condition to investigate in ALTE cases.
- Accurate diagnosis of gastroesophageal reflux is crucial for managing ALTE in infants.
Purpose:
- To evaluate the effectiveness of intraluminal impedance for diagnosing gastroesophageal reflux in infants presenting with ALTE.
- To characterize gastroesophageal reflux associated with ALTE using impedance measurements.
- To compare reflux rates in ALTE infants with healthy populations.
Summary:
- Intraluminal esophageal impedance was used to study 16 infants (1-6 months) with ALTE.
- Impedance detected significantly more reflux episodes (70.88) than pHmetry (23.4), distinguishing between acid and weakly acidic reflux.
- A statistically significant association between reflux and apnea was observed in only one patient.
Impact:
- Intraluminal impedance is a valuable tool for diagnosing gastroesophageal reflux in infants with ALTE.
- The technique differentiates between acid and non-acid reflux, providing detailed diagnostic information.
- Findings suggest ALTE infants do not have higher reflux rates than healthy infants, with apnea-reflux links being infrequent.
Background:
Apparent life threatening events (ALTE) affect children younger than one year. This syndrome is characterized by several symptoms: apnoea, change in colour or muscle tone, coughing or gagging. Approximately 50 percent of these children are diagnosed of an underlying pathology that explains the ALTEs, being gastroesophageal reflux one of the most important conditions to investigate.
Aim:
To demonstrate the effectiveness of intraluminal impedance technique for the diagnosis of the gastroesophageal reflux associated to ALTEs in infants.
Materials And Methods:
Stationary esophageal manometric is used to define the low esophageal sphincter, a pH and impedance 24 hours was recorded. We determinate association between gastroesophageal reflux-ALTEs and characterisation of the reflux that occurs.
Results:
Intraluminal esophageal impedance has been made to 16 children with the diagnosis of ALTEs between 1 and 6 months of age (mean of age 3.04 months). 23.4 episodes of reflux (9,500-31,275, P25 and P75 respectively) have been diagnosed by pHmetry whereas with impedance the number of reflux obtained were 70.88 (60.25 - 80.00), 36.21% acid and 63.78% weakly acidic. We have found 4 episodes of apnoea in one patient that seems to be connected with gastroesophageal reflux (3 nonacid and one acid event) in a statistically positive relation (SI > or = 50%; SSI > or = 10%).
Conclusions:
Intraluminal gastroesophageal impedance is a useful method for the diagnosis of gastroesophageal reflux in infants who present a gastric alkaline content most of time, allowing in addition, to differentiate between acid and nonacid reflux. According to our sample, the patients with the diagnosis of ALTEs do not present greater rate of gastroesophageal reflux than the healthy population of the same age. Only in one patient we have found a statistically significant relation between reflux and apnoea.
