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Updated: Apr 26, 2026
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Combined multichannel intraluminal impedance-pH (MII-pH): multicenter report of normal values from 117 children
Hayat Mousa1, Rodrigo Machado, Marina Orsi
1Division of Pediatric Gastroenterology, Nationwide Children's Hospital, 700 Children's Drive, JW 1985, Columbus, OH, USA, hayat.mousa@nationwidechildrens.org.
Insights
This study establishes normal non-acid gastroesophageal reflux (NAGER) impedance values for infants and children. These reference ranges aid in identifying pediatric patients potentially at risk for GER-related complications.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Technology
- Reflux Monitoring
Background:
- Combined multichannel intraluminal impedance/esophageal pH monitoring (MII-pH) is standard for pediatric GER assessment.
- Current MII-pH use lacks established reference values for non-acid GER (NAGER).
- This gap hinders accurate diagnosis of NAGER in children.
Purpose of the Study:
- To determine normal ranges for NAGER impedance values in infants and children.
- To provide reference data for NAGER parameters.
- To aid in identifying pediatric GER with potential clinical manifestations.
Main Methods:
- Analysis of EPM/MII tracings from pediatric GER assessment referrals.
- Exclusion of patients with abnormal acid GER indices, symptom association, or anti-reflux interventions.
- Calculation of NAGER percent time, episode frequency, proximal frequency, and mean duration.
Main Results:
- Data collected from 46 infants and 71 children across multiple centers.
- Established NAGER impedance value ranges for upright, recumbent, and total positions.
- Provided specific NAGER metrics for normal pediatric GER assessments.
Conclusions:
- The study provides crucial reference values for NAGER impedance in pediatric populations.
- These normal ranges can help identify infants and children with abnormal GER patterns.
- This facilitates early detection of potential GER-related clinical issues.
Abstract:
Although combined multichannel intraluminal impedance/esophageal pH monitoring (MII-pH) has replaced prolonged pH monitoring alone for assessing gastroesophageal reflux (GER) in the pediatric population, it does so in the absence of reference values for non-acid GER (NAGER). The purpose of this study was to identify a normal range of NAGER impedance values for infants and children. We evaluated EPM/MII tracings for patients referred for GER assessment to Nationwide Children's Hospital (Columbus, OH), Inova Children's Hospital, and Hospital Italiano (Buenos Aires, Argentina). We excluded tracings from patients who had AGER indices greater than 50 % of the upper end of normal (i.e., >3 % for children >12 months and >6 % for infants ≤ 12 months), had a positive temporal association of GER with symptoms, were on anti-reflux medications at the time of the study, and/or had a fundoplication prior to the study. We also excluded studies with durations shorter than 20 h. Values for NAGER percent time, NAGER episode frequency, frequency of proximal NAGER, and mean NAGER duration were calculated for upright position, recumbent, and total. Study population consisted of 46 infants (20 female [F]/26 male [M], median age 4.8 months [range 3 weeks-11.9 months]) with a median AGER index of 2.2 % (range 0.0-5.9 %) and 71 children (22 F/49 M, median age 7.2 years [range 1.3-17 years]) with a median AGER index of 1.1 % (range 0-3.0 %). Data are presented in tables in the text. The results of this study provide a range of values characteristic of infants and children with normal AGER indices and no positive temporal associations of GER with symptoms. These values may be used as references for comparison to identify infants and/or children who may be at risk of developing serious clinical manifestations due to abnormal patterns of GER.
