Impedance and extraesophageal manifestations of reflux in pediatrics

Area of Science:

• Pediatric Gastroenterology
• Otolaryngology
• Pulmonology

Background:

• Extraesophageal manifestations of gastroesophageal reflux (GER) are common in children, including cough, asthma, and hoarseness.
• Multichannel intraluminal impedance-pH (MII-pH) monitoring is used to evaluate GER, but its role in diagnosing extraesophageal symptoms is not fully established.

Purpose of the Study:

• To determine the association between extraesophageal signs and symptoms and pathological acid or nonacid reflux in children.
• To evaluate the utility of MII-pH monitoring in diagnosing GER-related extraesophageal manifestations.

Main Methods:

• Retrospective chart review of patients aged 0-21 years who underwent MII-pH monitoring for extraesophageal symptoms.
• Analysis of MII-pH data using dedicated software and manual review, calculating DeMeester scores and impedance parameters.
• Assessment of symptom association with reflux events using symptom indexes.

Main Results:

• Sixty-three pediatric patients met inclusion criteria; cough was the most common indication.
• Only six children (9.5%) had pathological GER based on DeMeester score.
• Ten patients (15.9%) had abnormal MII-pH evaluations using impedance criteria.
• A significant association between symptoms and reflux events was found in only seven patients (11.1%).

Conclusions:

• No significant association was demonstrated between extraesophageal signs/symptoms and pathological GER (acid or nonacid) in children.
• MII-pH monitoring, using current criteria, may not reliably identify GER as the cause of extraesophageal symptoms in this pediatric population.