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Updated: Aug 5, 2026
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Are there age-related differences in the frequency of post-reflux peristaltic waves during impedance-pH monitoring?
Judith Cohen Sabban1, Jhoanna Valery Adauto Luizaga1, Florencia Grisel Ursino1
1Pediatric Gastroenterology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Insights
Infants under two years old have reduced esophageal chemical clearance, indicated by a lower post-reflux swallow-induced peristaltic wave (PSPW) index. This suggests age-specific interpretation is crucial for evaluating pediatric gastroesophageal reflux (GER).
Area of Science:
- Pediatric Gastroenterology
- Esophageal Physiology
- Reflux Monitoring
Background:
- The post-reflux swallow-induced peristaltic wave (PSPW) is a key indicator of esophageal chemical clearance.
- Limited pediatric data exists on PSPW behavior across different age groups.
Purpose of the Study:
- To evaluate the behavior of the PSPW in children of various ages.
- To assess age-related differences in esophageal chemical clearance in pediatric patients.
Main Methods:
- Retrospective analysis of pediatric multichannel intraluminal pH/impedance studies for suspected gastroesophageal reflux (GER).
- Patients were stratified into three age groups: 0-2 years, >2-10 years, and >10-18 years.
- Manual calculation of the PSPW index for all included patients.
Main Results:
- Infants (0-2 years) exhibited significantly more reflux events, predominantly non-acid reflux with greater proximal extent.
- The PSPW index was significantly lower in the youngest group (42.1%) compared to older children (52.6% and 50.0%).
- These findings indicate reduced chemical clearance in infants.
Conclusions:
- Infants ≤2 years demonstrate increased GER episodes, a higher prevalence of non-acid reflux, and diminished esophageal chemical clearance (lower PSPW index).
- Age-specific interpretation of PSPW is recommended for improved evaluation and management of pediatric GER.
- This study highlights age-related variations in esophageal clearance mechanisms.
Objectives:
The post-reflux swallow-induced peristaltic wave (PSPW) reflects esophageal chemical clearance. Pediatric data on this parameter remain limited. The aim of this study was to evaluate the behavior of the PSPW in children of different ages.
Methods:
We conducted a retrospective analysis of pediatric multichannel intraluminal pH/impedance, studies were performed for suspected gastroesophageal reflux (GER). We included those with a normal reflux index, symptom index <50%, symptom association probability <95% and a number of reflux episodes within normal parameters for age. Patients were divided into three groups according to their age: Group I (0-≤2 years), Group II (>2-≤10 years), and Group III (>10-≤18 years). The PSPW index was calculated manually.
Results:
Two hundred and sixty-one studies were analyzed, 195 were included (median age 6.3 years, 54% female). Group I showed significantly more reflux events (38 vs. 26 and 32 in Groups II-III, p = 0.004) with predominance of non-acid reflux (p < 0.001) and greater proximal extent (p = 0.005). PSPW index was significantly lower in Group I (42.1%) compared to Groups II (52.6%) and III (50.0%) (p = 0.009).
Conclusions:
In this pediatric cohort, a higher number of gastroesophageal reflux episodes, a predominance of non-acid reflux and greater proximal extent were observed in infants ≤2 years, as well as reduced chemical clearance, which is reflected in a lower PSPW index compared to the other groups analyzed. Age-specific interpretation of PSPW could improve the evaluation of pediatric GER and therapeutic management.
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