Diagnostic accuracy of pH monitoring in gastro-oesophageal reflux
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L Da Dalt1, S Mazzoleni, G Montini
1Department of Paediatrics, University of Padova, Italy.
Insights
Twenty-four hour oesophageal pH monitoring is a highly sensitive and specific tool for diagnosing gastro-oesophageal reflux in children. Abnormal pH monitoring results indicate a higher likelihood of needing surgery for reflux disease.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Accuracy Studies
Background:
- Gastro-oesophageal reflux (GER) is a common condition in children.
- Accurate diagnosis is crucial for appropriate management and to avoid unnecessary interventions.
Purpose of the Study:
- To evaluate the diagnostic utility of 24-hour oesophageal pH monitoring in children with suspected GER.
- To determine the sensitivity and specificity of pH monitoring in identifying GER.
Main Methods:
- A prospective study of 111 children with suspected GER.
- 24-hour oesophageal pH monitoring was the initial investigation.
- Barium swallow and/or oesophagoscopy were performed selectively in children with abnormal pH findings.
- Patients received medical treatment for 1-12 months, with follow-up for 8 months to 2 years.
Main Results:
- Oesophageal pH monitoring demonstrated 100% sensitivity and 94% specificity for diagnosing GER.
- Abnormal pH monitoring correctly identified all GER cases.
- 66 out of 70 patients with non-GER diagnoses had normal pH studies.
- Children with >27% reflux time or >20 reflux episodes/hour required surgery.
Conclusions:
- 24-hour oesophageal pH monitoring should be the primary diagnostic tool for suspected GER in children.
- pH monitoring, combined with clinical data, aids in identifying children who may require surgical intervention.
Abstract:
One hundred and eleven children admitted with suspected gastro-oesophageal reflux were studied, with 24 hour oesophageal pH monitoring as the first line of investigation. Barium swallow examination, or oesophagoscopy, or both, were carried out only in children with abnormal pH, who subsequently had a trial of 1-12 months medical treatment. All patients were followed up for eight months to two years. A final diagnosis of gastro-oesophageal reflux was made in 41 patients, in all of whom the pH study was abnormal (100% sensitivity). The final diagnosis was different in 70 patients; 66 of these had a normal pH (94% specificity). All children with gastro-oesophageal reflux were treated with drugs. All those with a percentage reflux time of more than 27 and more than 20 episodes of reflux lasting more than 5 minutes failed to improve and needed operation. We conclude that monitoring of the oesophageal pH should be the first line of investigation in patients with gastro-oesophageal reflux and should be used together with clinical data and other investigations, to identify those children who will need operation.