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Updated: Aug 23, 2025
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Symptom Scores and pH-Impedance: Secondary Analysis of a Randomized Controlled Trial in Infants Treated for
Zakia Sultana1,2, Kathryn A Hasenstab1,2, Rebecca K Moore1,2
1Innovative Infant Feeding Disorders Research Program, Nationwide Children's Hospital, Columbus, Ohio.
Insights
The Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R) shows limited diagnostic value for gastroesophageal reflux disease (GERD) in high-risk infants. Acid-suppressive medications with feeding modifications did not improve symptoms or pH-impedance metrics.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Motility Disorders
- Infant Nutrition
Background:
- Gastroesophageal reflux (GER) is common in infants, leading to diagnostic challenges.
- Accurate assessment of GER symptoms and objective measurement are crucial for appropriate management.
- High-risk infants often require specialized evaluation for GER disease (GERD).
Purpose of the Study:
- To compare gastro-esophageal reflux (GER) symptom scores with pH-impedance measurements in high-risk infants.
- To evaluate the efficacy of acid-suppressive medications, with or without feeding modifications, on GER symptoms and pH-impedance parameters.
- To assess the diagnostic utility of the Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R).
Main Methods:
- Analysis of 24-hour pH-impedance data and I-GERQ-R scores from 94 high-risk infants.
- Longitudinal study of 40 infants receiving randomized therapy (proton pump inhibitor [PPI] with or without feeding modifications) for 4 weeks.
- Examination of correlations between I-GERQ-R scores and pH-impedance metrics, including acid reflux index and bolus GER events.
Main Results:
- Weak correlations were observed between I-GERQ-R scores and pH-impedance metrics.
- The I-GERQ-R demonstrated suboptimal sensitivity and specificity but high negative predictive value for certain GERD indicators.
- Proton pump inhibitor (PPI) therapy with feeding modifications did not improve symptom scores or pH-impedance metrics; however, bolus clearance worsened in both treatment groups.
Conclusions:
- The I-GERQ-R may serve as a screening tool to help rule out acid GER disease, but further diagnostic testing is necessary.
- Acid-suppressive therapy combined with feeding modifications showed no significant benefit on symptom scores or pH-impedance parameters in this cohort.
- Worsened refluxate clearance despite PPI therapy suggests potential pharyngoesophageal dysmotility, necessitating placebo-controlled trials with objective pH-impedance criteria.
Background And Aims:
To evaluate and compare gastro-esophageal reflux (GER) symptom scores with pH-impedance and test the effects of acid-suppressive medications with or without feeding modifications on pH-impedance in high-risk infants.
Methods:
Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R) and 24-hour pH-impedance data were analyzed from 94 infants evaluated in a tertiary care setting for GER disease. Longitudinal data from 40 infants that received randomized GER therapy (proton pump inhibitor [PPI] with or without feeding modifications) for 4 weeks followed by 1-week washout were analyzed. Relationships between I-GERQ-R and pH-impedance metrics (acid reflux index, acid and bolus GER events, distal baseline impedance, and symptoms) were examined and effects of treatments compared.
Results:
(A) Correlations between I-GERQ-R and pH-impedance metrics were weak. (B) I-GERQ-R sensitivity, specificity, and positive predictive values were suboptimal when correlated with pH-impedance metrics. I-GERQ-R negative predictive value (NPV) was high for acid symptom-association probability (NPV = 84%) and distal baseline impedence (NPV = 86%) thresholds. (C) PPI with feeding modifications (vs PPI alone) did not alter pH-impedance metrics or symptom scores (P > .05); however, bolus clearance metrics worsened for both treatment groups (P < .05).
Conclusions:
In high-risk infants (1) I-GERQ-R may be a helpful clinical screening tool to exclude acid-GER disease diagnosis and minimize unnecessary acid-suppressive treatment, but further testing is needed for diagnosis. (2) Acid-suppressive therapy with feeding modifications has no effect on symptom scores or pH-impedance metrics. Clearance of refluxate worsened despite PPI therapy, which may signal development of pharyngoesophageal dysmotility and persistence of symptoms. (3) Placebo-controlled trials are needed in high-risk infants with objective pH-impedance criteria to determine efficacy, safety, and underlying mechanisms. Clinicaltrials.gov ID: NCT02486263.
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