Related Experiment Video
Updated: Jun 14, 2025
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Evaluation of Gastroesophageal Reflux in Symptomatic Young Infants Using Multichannel Intraluminal pH-Impedance
Rochelle Sequeira Gomes1, Michael Favara1, Sheeja Abraham2
1Department of Neonatology, Thomas Jefferson University/Nemours, Philadelphia, Pennsylvania.
Insights
Multichannel intraluminal impedance and pH (MII-pH) studies help characterize gastroesophageal reflux disease (GERD) in infants. Symptom association with reflux occurs even without frequent or acidic reflux events in many cases.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Technologies
Background:
- Gastroesophageal reflux disease (GERD) is common in infants, presenting with diverse symptoms.
- Accurate diagnosis is crucial to differentiate GERD from other conditions and avoid unnecessary treatments.
- Multichannel intraluminal impedance and pH (MII-pH) studies offer a comprehensive method for evaluating reflux events.
Purpose of the Study:
- To assess the utility of MII-pH in a large cohort of symptomatic young infants.
- To characterize the occurrence and nature of gastroesophageal reflux (GER) in this population.
- To establish the temporal association between reflux events and infant symptoms using validated indices.
Main Methods:
- Retrospective cohort study of 181 infants with suspected GERD undergoing MII-pH.
- Analysis of over 4,000 hours of data, identifying 8,480 reflux events (acidic and nonacidic).
- Utilized Symptom Index (SI) and Symptom Association Probability (SAP) to link symptoms with reflux; defined pathological reflux by event frequency or acid reflux index.
Main Results:
- 62.4% of infants showed positive symptom association with reflux events.
- Only 16% of infants had pathological reflux, and 10% had both pathological reflux and symptom association.
- Nonacidic reflux was more common than acidic reflux; symptom association was modest for choking/gagging and poor for apnea/bradycardia/desaturations.
Conclusions:
- MII-pH is effective for characterizing GERD and temporal symptom association in infants.
- Pathological reflux is uncommon in symptomatic infants, but symptoms can be linked to reflux without frequent or acidic events.
- MII-pH aids in identifying true GERD, potentially reducing unwarranted therapies.
Objective:
This study aimed to assess the use of combined multichannel intraluminal impedance and pH studies (MII-pH) in a large group of symptomatic young infants, to characterize the occurrence of gastroesophageal reflux disease (GERD), and to establish temporal association of the reflux behaviors with gastroesophageal reflux using symptom indices.
Study Design:
This is a retrospective cohort study on 181 infants who underwent MII-pH studies for clinical behaviors that were suggestive of GERD. Symptom index (SI) and symptom association probability (SAP) were used to establish symptom association with reflux. More than 100 GER episodes in 24 hours or acid reflux index > 10% was considered pathological reflux.
Results:
A total of 181 infants (median age: 60 days, interquartile range [IQR]: 34-108) underwent MII-pH studies with median study duration of 22.41 hours (IQR: 21.5-23.32). A total of 4,070 hours of data were analyzed, with 8,480 reflux events (2,996 [35%] acidic, 5,484 [65%] nonacidic). A total of 2,541 symptoms were noted, 894 (35%) were temporally related to reflux events. A total of 113 infants (62.4%) had positive symptom association with SI > 50% and/or SAP > 95% for at least one symptom. There was modest symptom association for choking and gagging, but apnea, bradycardia, and desaturations had poor symptom association. Only 29 infants (16%) had pathological reflux, and only 18 infants (10%) had both pathological reflux and positive symptom association.
Conclusion:
MII-pH can be used to characterize GERD in young infants, along with establishing temporal association with symptoms. Pathological reflux in symptomatic young infants is not common, but symptom association may occur without frequent or acidic reflux.
Key Points:
· Gastroesophageal reflux (GER) disease can be studied in young infants using MII-pH, to characterize the frequency and nature of GER events.. · The probability of GER events being associated temporally with GER symptoms can also be determined using MII-pH in this population.. · Using frequency of GER events, reflux indices, and symptom association indices with MII-pH, infants having true GER disease can be identified, thereby reducing unnecessary therapy.. · Symptom association may occur even without frequent or severe acidic reflux..
More Related Videos
08:25Construction of a Wireless-Enabled Endoscopically Implantable Sensor for pH Monitoring with Zero-Bias Schottky Diode-based Receiver
Published on: August 27, 2021
08:22Measuring Cardiac Autonomic Nervous System ANS Activity in Toddlers - Resting and Developmental Challenges
Published on: February 25, 2016
Related Concept Videos
01:29Gastroesophageal Reflux Disease II: Clinical Features and Management
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...
01:24Upper GI Series: Barium Swallow
Purpose and Procedure
Patients undergoing this procedure ingest a liquid containing barium sulfate with a chalky...
01:30Esophageal Strictures-I: Introduction
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...