[False negatives in pH measurement. A retrospective study of 12 surgical cases]

Extended esophageal pH-metering is the best method for GER diagnosis, but it has a certain number of false negatives. In a attempt to judge in which extent we can indicate surgery with a "normal" pH-metering study, we have reviewed our 110 operated children since 1982, and selected 12 in whom pH studies were normal. There where five females and seven males with ages ranging between 18 and 90 months. The clinical course until the diagnosis was accepted was long. Nine patients had vomiting, five respiratory disease, six dysphagia, four anemia and three torticollis. Only two were malnourished. There was radiologic GER in all children (with only one hiatal hernia). In spite of "normal" pH-metering, eight had decreased lower esophageal sphincter, and 11 disturbed motility. Nine had endoscopic esophagitis and eight histologic esophagitis. After operation, indicated only after long periods of medical treatment, vomiting disappeared in all, and so did respiratory disease and torticollis. Five families were very satisfied, six rather satisfied (gas bloat syndrome) and one frankly dissatisfied (dysphagia with severe immotility). Based on this evidence, we believe that some limited indications for surgery in GER are acceptable even in the presence of "normal" pH-studies.