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Simultaneous pH recordings from multiple esophageal sites in children with and without distal gastroesophageal reflux
1Division of Pediatric Gastroenterology and Pediatric Surgery, Children's Hospital, Denver, Colorado 80218.
Insights
Children with abnormal acid reflux have reduced protection in the upper esophagus when lying down. This contrasts with healthy children, who show significantly less acid exposure proximally.
Area of Science:
- Gastroenterology
- Pediatric Medicine
- Physiology
Background:
- Gastroesophageal reflux disease (GERD) is common in children.
- Assessing the extent of esophageal acid exposure is crucial for diagnosis and management.
- Previous studies primarily focused on distal esophageal pH monitoring.
Purpose of the Study:
- To investigate simultaneous esophageal pH monitoring at multiple sites in children.
- To compare acid reflux patterns in the proximal versus distal esophagus in children with normal and abnormal distal pH studies.
- To evaluate the protective capacity of the upper esophagus against acid reflux in recumbent children.
Main Methods:
- Continuous, simultaneous esophageal pH recordings from three sites (distal, middle, proximal) over 18-24 hours in children.
- Utilized a flexible catheter with four antimony microelectrodes and a portable recorder.
- Computer analysis of key parameters: percent time pH < 4.0, reflux episodes/hour, acid clearance time, and longest reflux duration, analyzed separately for upright and recumbent positions.
Main Results:
- In healthy children (Group I), recumbent position showed significantly decreased acid exposure from distal to proximal esophagus.
- In children with abnormal reflux (Group II), the proximal esophagus exhibited high acid exposure, with a less pronounced decrease from distal to proximal compared to Group I.
- The upper esophagus's protection against acid reflux is diminished in children with abnormal reflux scores when recumbent.
Conclusions:
- Simultaneous multi-site esophageal pH monitoring provides a more comprehensive assessment of acid reflux.
- Children with abnormal distal esophageal pH recordings have impaired upper esophageal protection against acid reflux, particularly when recumbent.
- These findings highlight the importance of considering proximal esophageal acid exposure in pediatric GERD evaluation.
Abstract:
We made continuous, simultaneous recordings of esophageal pH from three sites in the esophageal body, for 18-24 h, in 11 children with normal prolonged distal esophageal pH studies (Group I) and in 14 children with abnormal distal esophageal pH recordings (Group II). A flexible catheter housing four antimony microelectrodes was used, and data were stored in a portable recorder. A computer allowed for evaluation of the percent of time esophageal pH was less than 4.0, number of reflux episodes per hour, acid clearance time, and the duration of longest reflux episode. Recordings made while subjects were upright or recumbent could be distinguished and analyzed separately. In the recumbent position, comparison of pH recordings from distal, middle, and proximal esophageal pH electrodes in Group I showed significant decreases in the percent of time spent with pH less than 4.0, reflux episodes per hour, acid clearance time, and duration of longest reflux episode in the proximal esophageal sites, with a near negligible total acid exposure in the most proximal electrode. In Group II subjects, however, comparison of recumbent recordings from distal, middle, and proximal esophagus indicates that the proximal esophagus is highly exposed to acid reflux and that the decrease in acid exposure from distal to proximal esophagus in reflux patients is not proportionally as great as that of Group I. The data suggest that in the recumbent position, the ability of the subjects with abnormal reflux scores to protect the upper esophagus is less than that of subjects with normal amounts of distal esophageal acid exposure.