Related Experiment Video
Updated: Apr 23, 2026
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Follow-up after pH-metry and pH impedance in pediatric gastroesophageal reflux disease
Rachel J van der Pol1, Marloes van den Ouweland, Clara M Loots
1*Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital AMC, Amsterdam, The Netherlands †Department of Pediatric Gastroenterology and Nutrition, UZ Brussels, Brussels, Belgium.
Insights
In infants, a high reflux index (RI) from pH-metry predicts ongoing gastrointestinal symptoms and increased symptom burden for up to a year. This association was not observed in older children.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Testing
- Reflux Disease Management
Background:
- Gastroesophageal reflux disease (GERD) diagnosis in children often relies on symptom presentation.
- The correlation between diagnostic test results and the longitudinal course of GERD symptoms in pediatric populations remains unclear.
- Understanding this relationship is crucial for effective patient management and prognosis.
Purpose of the Study:
- To investigate the association between diagnostic reflux testing parameters and the subsequent symptom course in infants and children with suspected GERD.
- To determine if baseline reflux index (RI) predicts symptom burden and persistence over a 12-month follow-up period.
- To differentiate findings between infants and older children.
Main Methods:
- A prospective study included 162 infants and 42 children (0-18 years) undergoing pH-metry or pH-multichannel intraluminal impedance (MII) over one year.
- Baseline reflux index (RI) and gastrointestinal (GI) symptoms were recorded.
- Participants completed questionnaires on medical history, GI and extraesophageal symptoms, symptom burden, and medication use at baseline and at 3, 6, and 12 months.
Main Results:
- In infants, a higher baseline RI was significantly associated with a greater symptom burden at baseline and at 3 and 12 months.
- Baseline RI and reported GI symptoms at 3 months were also significantly linked in infants.
- Infants and children on medication reported higher symptom burden compared to non-medicated individuals at all follow-up points.
Conclusions:
- In infants, an elevated baseline reflux index (RI) is predictive of persistent GI symptoms and increased symptom burden throughout a one-year follow-up.
- No significant association between baseline RI and symptom course was found in older children.
- Medication use correlated with higher symptom burden in both infants and children, irrespective of reflux testing results.
Objectives:
It is unclear how diagnostic tests for gastroesophageal reflux disease (GERD) in children relate to the course of symptoms during follow-up.
Methods:
During 1 year, all children (ages 0-18 years), who underwent pH-metry and/or pH multichannel intraluminal impedance (MII), were included after written informed consent was obtained. pH-metry and pH-MII test characteristics, such as reflux index (RI, % time that esophageal pH < 4), were obtained from the measurements. A questionnaire containing subcategories (medical history, gastrointestinal [GI] symptoms, extraesophageal symptoms, symptom burden, and therapeutic agents) was used; subjects were asked to fill the questionnaire at the time of inclusion and 3, 6, and 12 months afterward.
Results:
A total of 162 infants and 42 children were included. pH-MII was performed in 15.4% and 57.4% of infants and children, respectively. All of the other subjects underwent pH-metry. Median RI was 2.0% (interquartile range 3.4) in infants and 1.7% (interquartile range 2.3) in children. RI was considered positive in 6.8% and 12.8% of infants and children, respectively. In infants, RI at baseline was significantly associated with symptom burden at baseline and at 3 and 12 months of follow-up. RI at baseline and reported GI symptoms at 3 months were also significantly associated. In infants and children using medication, symptom burden was significantly higher compared with those not using medication. This difference was found at baseline, after 3 and 12 months.
Conclusions:
In infants, an initial high RI is associated with persistence of GI symptoms at 3 months and a higher burden of symptoms during the course of 1 year. In children there were no such findings.
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