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Updated: May 8, 2026
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Results of multichannel intraluminal impedance pH metry in symptomathic children with normal pH metry findings
Tutku Soyer1, Fulya Gulerman2, Ozlem Boybeyi3
1Department of Pediatric Surgery, School of Medicine, Hacettepe University, Ankara, Turkey.
Insights
Multichannel intraluminal impedance (MII) is superior to pH monitoring (PM) for detecting weak acid and alkaline reflux in children with persistent symptoms and normal PM results. MII also assesses esophageal clearance and reflux extent.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Esophageal Motility Disorders
Background:
- Recurrent symptoms in children can be challenging to diagnose.
- Standard pH monitoring (PM) may yield normal findings despite persistent symptoms.
- Multichannel intraluminal impedance (MII) offers a complementary approach to evaluate esophageal function.
Purpose of the Study:
- To evaluate the efficacy of multichannel intraluminal impedance (MII) pH metry in children with normal pH monitoring (PM) findings.
- To identify reflux patterns not detected by conventional PM.
Main Methods:
- Retrospective analysis of symptomatic children with normal PM (reflux index < 4%).
- All participants underwent MII to assess reflux index (RI), reflux content (acid, weak acid, alkaline), impedance events, bolus clearance, and proximal extent of reflux (PER).
- Exclusion of patients already on antireflux treatment.
Main Results:
- MII identified abnormal reflux (RI > 4%) in 50% of the eight included pediatric patients.
- Weak acid and alkaline reflux were detected in patients with normal PM findings.
- Abnormal reflux episodes (≥70) and prolonged esophageal clearance time were observed in specific subgroups.
Conclusions:
- MII is a valuable tool for diagnosing weak acid and alkaline reflux in children with persistent symptoms and normal PM.
- MII provides comprehensive data on reflux content, impedance events, and esophageal clearance, enhancing diagnostic capabilities.
Aim:
A retrospective study was performed to evaluate the results of multichannel intraluminal impedance (MII) pH metry in symptomatic children with normal pH monitoring (PM) findings.
Patients And Methods:
Children who have reflux index (RI) less than 4% in PM and recurrent symptoms were included. All children underwent MII. Children who received antireflux treatment with normal PM findings were excluded from the study. MII results were evaluated for RI, content of reflux (acid, weak acid, and alkaline) number and type of impedance events, esophageal bolus clearance time and proximal extent of reflux (PER).
Results:
Eight patients (age range: 5-13 years) were included to the study. The male female ratio was 5:3. The recurrent symptoms were related with gastrointestinal (n = 5) and upper respiratory system (n = 3). One of the patients was operated for esophageal atresia and one was followed for corrosive esophageal disease. Four of the patients had RI higher than 4% in MII. Patients with normal RI in MII, had weak acid reflux (n: 1), alkaline reflux (n = 1) and no reflux (n = 2). When number of impedance events evaluated, four patients had abnormal reflux episodes (70 or more reflux episodes). Impedance event recordings were correlated in 75% of PM findings. The content of impedance events were mixed and gas in nature. Prolonged esophageal clearance time and PER were detected in patients with chest pain and operated esophageal atresia.
Conclusion:
MII can be considered as a superior diagnostic tool to detect weak acid and alkaline reflux in patients who had recurrent symptoms with normal PM studies. MII also provides information about bolus clearance time and extent of reflux.
