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[Esophageal pH-metry and gastroesophageal reflux in infants and children]
Insights
Gastroesophageal reflux in infants can be diagnosed using pH monitoring. A reflux time percentage below pH 4 exceeding 5.2% offers the best diagnostic value for infant reflux.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Medicine
- Esophageal Physiology
Context:
- Gastroesophageal reflux (GER) is common in infants, presenting diagnostic challenges.
- Accurate diagnosis is crucial for appropriate management and to prevent complications.
- Continuous esophageal pH monitoring is a key diagnostic tool for GER.
Purpose:
- To evaluate the diagnostic accuracy of various esophageal pH monitoring parameters in infants with suspected gastroesophageal reflux.
- To identify the most discriminative pH parameters for diagnosing GER in children under three years old.
Summary:
- Twenty-five infants (16 with GER symptoms, 9 controls) underwent 18–24 hour esophageal pH monitoring.
- Parameters evaluated included time below pH 4, reflux episode frequency, longest reflux duration, and number of prolonged reflux episodes.
- A reflux time percentage below pH 4 greater than 5.2% demonstrated the highest diagnostic value (69% sensitivity, 89% specificity).
- Shorter 2–3 hour postprandial pH recordings with a reflux score also showed good diagnostic utility, similar to adult assessments.
Impact:
- Establishes that a specific percentage of reflux time below pH 4 is a reliable indicator for diagnosing infant GER.
- Highlights the utility of shorter postprandial pH monitoring with reflux scoring in clinical practice.
- Recommends incorporating discriminant pH parameters into diagnostic criteria for infant gastroesophageal reflux.
Abstract:
Twenty five infants, all under 3-year-old, 16 with symptoms of gastroesophageal reflux and 9 controls, were studied by continuous pH esophageal monitoring during 18 to 24 h. The diagnostic value of several pH parameters was calculated in reference to the upper limits of normal ranges previously determined in other studies performed in similarly aged children. Sensitivity and specificity of these parameters were respectively 69 and 89 p. 100 for the time elapsed below pH 4, 44 and 100 p. 100 for the number of reflux episodes per hour, 56 and 89 p. 100 for the duration of the longest episode of reflux, and 31 and 100 p. 100 for the number of reflux episodes lasting more than 5 min. These results confirm that a percentage Of reflux time (less than pH 4) longer than 5.2 p. 100 of the total duration of pH recording has the best discriminative value. However in clinical practice 2 or 3 h postprandial pH recording have a good diagnostic value when the results are expressed using a reflux score, as in adult patients. In further studies concerning gastroesophageal reflux in infants, it is concluded that diagnostic criteria must include evidence of reflux using a discriminant pH parameter.