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Updated: Nov 30, 2025
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Response to therapy among neonates with gastro-esophageal reflux is associated with esophageal clearance
Stefano Nobile1, Fabio Meneghin2, Paolo Marchionni3
1Neonatal Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; Department of Mother and Child Health, Salesi Children's Hospital, via Corridoni 11, 60100 Ancona, Italy.
Insights
In newborns with gastro-esophageal reflux disease (GERD), clinical response to therapy correlated with improved esophageal clearance, not esophageal basal impedance (BI). This finding impacts treatment strategies for infant GERD.
Area of Science:
- Pediatric Gastroenterology
- Neonatal Medicine
- Pharmacological Research
Background:
- Limited research exists on pharmacological therapy for gastro-esophageal reflux disease (GERD) in newborns, with safety concerns raised.
- Esophageal basal impedance (BI) indicates mucosal integrity, and while proton pump inhibitors increase BI in infants, a link to clinical improvement is unconfirmed.
Purpose of the Study:
- To investigate the relationship between esophageal pH-impedance parameters, including BI, and clinical outcomes in newborns treated for GERD.
- To determine if esophageal BI or other impedance parameters predict treatment response in infants with GERD.
Main Methods:
- A multicenter retrospective study analyzed data from 60 infants (51 preterm) treated with omeprazole or ranitidine for GERD.
- Clinical response was assessed at 2 and 4 weeks based on symptom reduction (≥50% for complete response).
- Statistical analysis, including univariate and multivariate methods, explored associations between clinical response and pH-impedance parameters.
Main Results:
- Treatment response in infants with GERD was significantly associated with decreased esophageal clearance time at both 2 weeks (OR 0.308) and 4 weeks (OR 0.461).
- No significant association was found between clinical response to GERD therapy and esophageal basal impedance (BI) levels.
Conclusions:
- Clinical improvement in newborns with GERD receiving pharmacological therapy is linked to enhanced esophageal clearance.
- Esophageal basal impedance (BI) levels do not appear to be a reliable predictor of clinical response in this patient population.
Background:
Few studies evaluated the efficacy of pharmacological therapy for gastro-esophageal reflux disease (GERD) in newborns, whose safety has been questioned. Esophageal basal impedance (BI) is a marker of mucosal integrity, and treatment with proton pump inhibitors significantly increases BI in infants; however, no correlation with clinical improvement was reported.
Aims:
To evaluate the relationship between BI and other esophageal pH-impedance parameters and clinical response to therapy in newborns with GERD.
Study Design:
Multicenter retrospective study.
Subjects:
Infants who received omeprazole or ranitidine for GERD.
Outcome Measures:
Complete response to therapy was defined as symptom decrease by ≥50% compared to baseline, partial response as symptom decrease <50%, no response as no symptom decrease based on chart analysis. Response to therapy was assessed 2 and 4 weeks after the onset of therapy. Univariate and multivariate statistics were performed to assess associations between response to therapy and clinical/pH-impedance parameters.
Results:
We studied 60 infants (51 born preterm): 47 received omeprazole, 13 ranitidine. Response to therapy was associated with decreasing esophageal clearance time: odds ratio 0.308, 95%CI 0.126-0.753, p = 0.010 at 2 weeks, odds ratio 0.461, 95%CI 0.223-0.955, p = 0.037 at 4 weeks.
Conclusions:
Clinical response to therapy among infants with GERD was associated with esophageal clearance but not with esophageal BI level.
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