Related Experiment Video
Updated: Jan 10, 2026
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Comprehensive Assessment of Reflux Burden and Mucosal Integrity in Children: Insights from MNBI and Impedance-pH
Felicia Galos1,2, Alexandra Ilie2, Mihai Daniel Luca Mirea2
1Division of Pediatrics, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Insights
Mean nocturnal baseline impedance (MNBI) shows promise as a marker for gastroesophageal reflux disease (GERD) in children, particularly older children. Further research is needed to establish pediatric reference values for this impedance measure.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Motility Disorders
- Esophageal Physiology
Background:
- Pediatric gastroesophageal reflux disease (GERD) diagnosis is challenging due to heterogeneous presentations.
- Multichannel intraluminal impedance and pH (MII-pH) monitoring is the gold standard for GERD diagnosis.
- Mean nocturnal baseline impedance (MNBI) is an emerging marker of mucosal integrity in adults, but pediatric data are lacking.
Purpose of the Study:
- To characterize age-related reflux patterns in children using MII-pH monitoring.
- To assess the association between MNBI and pathological acid exposure in pediatric GERD.
- To evaluate MNBI's diagnostic performance for identifying acid-mediated GERD in different age groups.
Main Methods:
- Retrospective analysis of 226 children undergoing 24-hour MII-pH monitoring.
- Stratification of patients into infants (<1 year) and older children (≥1 year).
- Correlation and ROC analysis to evaluate MNBI's association with reflux index (RI) and pathological acid exposure.
Main Results:
- Infants showed more liquid and weakly acidic reflux, while older children had more gas reflux.
- MNBI inversely correlated with RI in both age groups (p < 0.0001).
- MNBI demonstrated better diagnostic performance in older children (cut-offs ~2525-3079 Ω) than in infants for pathological acid exposure.
Conclusions:
- MNBI is a reproducible, age-sensitive marker of reflux burden in children.
- MNBI complements the reflux index (RI) in diagnosing acid-mediated GERD, especially in older children.
- Prospective studies are required to establish normative pediatric reference values for MNBI.
Background:
Pediatric gastroesophageal reflux disease (GERD) presents with heterogeneous phenotypes across ages, and diagnostic challenges persist. Multichannel intraluminal impedance and pH (MII-pH) monitoring is the current gold standard, while mean nocturnal baseline impedance (MNBI) has emerged as a marker of mucosal integrity in adults. Pediatric normative data are still lacking. We aim to characterize age-related reflux patterns and assess the association between MNBI and pathological acid exposure in children undergoing MII-pH monitoring.
Methods:
We retrospectively analyzed 226 children evaluated with 24 h MII-pH monitoring between 2017 and 2025. Clinical and laboratory data were reviewed. Children were stratified by age (<1 year vs. ≥1 year). Pathological reflux was defined as reflux index (RI) > 10% in infants and >7% in older children. MNBI was measured at distal channels (Z5, Z6) during nocturnal recumbency. Correlations between MNBI and RI were assessed. Diagnostic performance of MNBI for pathological acid exposure was evaluated using ROC analysis.
Results:
Infants had more total reflux episodes, particularly weakly acidic and liquid, whereas older children exhibited more gas reflux. MNBI correlated inversely with RI (Z6 r = -0.337; Z5 r = -0.281; both p < 0.0001). In infants, MNBI poorly discriminated pathological acid exposure. In older children, MNBI showed better performance, with optimal cut-offs of ~2525 Ω (Z6) and 3079 Ω (Z5) yielding specificities > 85%.
Conclusions:
MNBI is a reproducible, age-sensitive marker of reflux burden in children, best suited for older children where it complements RI in diagnosing acid-mediated GERD. Larger prospective studies are needed to establish pediatric reference values.
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
05:31Noninvasive Sampling of Mucosal Lining Fluid for the Quantification of In Vivo Upper Airway Immune-mediator Levels
Published on: August 7, 2017
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...
01:17Assessment of the Gastrointestinal System I: Subjective Data
Health History
The initial step in assessing the GI system is obtaining a comprehensive health history. This includes inquiring about the patient's history or presence of problems...
01:28Peptic Ulcer Disease III: Clinical Manifestations and Diagnostic Studies
Few clinical manifestations differentiate gastric ulcers from duodenal ulcers. Distinctions in the location, timing, and pain relief are crucial for healthcare providers in differentiating between gastric and duodenal ulcers during clinical assessments.
01:23Assessment of Respiration
Subjective Assessment: Nurses interview the patient to gather information directly during the subjective assessment. It includes questions about the individual's medical history, medications, and symptoms, focusing on past respiratory conditions like...
01:20Assessment of Ventilation I: Respiratory Rate
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
01:26Assessment of the Mouth
Mouth Inspection
The inspection begins with visually examining the mouth for symmetry, color, and size.