Low mean impedance in 24-hour tracings and esophagitis in children: a strong connection

Area of Science:

• Pediatric Gastroenterology
• Esophageal Physiology
• Diagnostic Tools

Background:

• Esophageal multiple intraluminal impedance (MII) baseline measures esophageal integrity.
• Previous studies suggest a link between MII baseline and esophageal health.
• Assessing MII's relationship with endoscopic findings in children is crucial.

Purpose of the Study:

• To evaluate the association between mean esophageal impedance values and endoscopic findings in pediatric patients.
• To determine if MII baseline can serve as a marker for esophageal integrity in children with reflux symptoms.

Main Methods:

• Retrospective analysis of 298 children undergoing endoscopy and 24-hour MII monitoring for gastroesophageal reflux symptoms.
• Esophagitis grading using the Los Angeles classification.
• Age-adjusted impedance values (z-scores) calculated using LMS method; statistical analysis included Mann-Whitney, Kruskal-Wallis, and regression models.

Main Results:

• Endoscopic esophagitis was present in 30% of patients.
• Significantly decreased median baseline impedance z-scores in both proximal and distal esophagus for patients with endoscopic esophagitis (P=0.02 and P=0.01, respectively).
• Lower z-scores correlated with more severe esophagitis; bolus exposure index and reflux episode count were associated with baseline z-score.

Conclusions:

• Mean esophageal impedance z-score is significantly reduced in infants and children diagnosed with endoscopic esophagitis.
• Impedance z-score may serve as a valuable, non-invasive indicator of esophageal integrity in pediatric reflux disease.
• Esophagitis severity, bolus exposure index, and reflux frequency are key determinants of esophageal impedance.