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Updated: Nov 16, 2025
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Measuring Gastric pH in Tube-fed Children With Neurologic Impairments and Gastroesophageal Disease
James Tjon1,2, Mitchell Cooper3, Michael Pe4
1Department of Pharmacy, The Hospital for Sick Children, Toronto.
Insights
Gastric pH monitoring in children with GERD using pH paper and handheld meters shows good agreement with laboratory measurements. These point-of-care tests are useful for monitoring gastric pH in tube-fed children.
Area of Science:
- Pediatric Gastroenterology
- Medical Device Evaluation
Background:
- Gastroesophageal reflux disease (GERD) is common in children with neurologic impairments.
- Accurate gastric pH monitoring is crucial for managing GERD in this population.
- Gastrostomy tubes are often used for feeding these children.
Purpose of the Study:
- To assess the agreement between pH paper and a handheld pH meter compared to a laboratory pH meter for gastric pH measurement.
- To evaluate the utility of point-of-care testing for gastric pH in children with neurologic impairments and GERD.
Main Methods:
- Prospective observational study involving 43 pediatric patients with gastrostomy tubes.
- Gastric pH was measured using pH paper, a handheld pH meter, and a laboratory pH meter (gold standard).
- Agreement was analyzed using intraclass correlation coefficient (ICC), Bland-Altman analysis, and kappa statistic.
Main Results:
- High ICC values were observed between the handheld meter and lab meter (0.75), and between pH paper and lab meter (0.69).
- Bland-Altman analysis showed minimal mean differences (-0.03 to 0.17 pH units) with acceptable limits of agreement.
- Kappa coefficients for pH ≥4 were excellent (1.0 and 0.9), indicating strong agreement.
Conclusions:
- Both pH paper and handheld pH meters demonstrate good correlation with laboratory pH measurements.
- These point-of-care tests are reliable and useful for monitoring gastric pH in tube-fed children with neurologic impairments and GERD.
Objectives:
The aim of the study was to determine the extent of agreement between pH paper and handheld pH meter with a laboratory pH meter for gastric pH measurement in children with neurologic impairments and gastrostomy tubes who have gastroesophageal reflux disease (GERD).
Methods:
In this prospective observational study, gastric contents were aspirated from gastric or nasogastric tubes and the pH measured using 3 techniques: pH paper, handheld pH meter, and laboratory pH meter (the gold standard). Agreement between techniques was assessed with intraclass correlation coefficient (ICC), Bland-Altman analysis, and kappa statistic.
Results:
Among 43 patients contributing 67 gastric samples, the ICC was 0.75 (95% confidence interval [CI]: 0.69-0.97) between the handheld and laboratory meters, 0.69 (95% CI: 0.63--0.94) between the pH paper and laboratory meter and 0.69 (95% CI: 0.63-0.94) between the handheld meter and paper. The Bland-Altman analysis between the handheld and lab meters showed a mean difference of -0.03 pH units (limits of agreement: -0.52 to 0.47 pH units) and 0.17 pH units (limits of agreement: -0.99 to 1.33 pH units) between the paper and lab meter. The kappa coefficients for a pH ≥4 were 1.0 (95% CI: 1.0--1.0) between the handheld and lab meters and 0.9 (95% CI: 0.77--1.0) between the paper and lab meter.
Conclusions:
The findings suggest that both point-of-care tests, the pH meter and pH paper, correlate well with the gold standard for testing pH with a laboratory pH meter, indicating usefulness in point-of-care testing for monitoring gastric pH in tube-fed children with neurologic impairments and GERD.
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