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Effect of general anaesthesia on prolonged intraoesophageal pH monitoring
W A McCallion1, T M Gallagher, V E Boston
1Department of Paediatric Surgery, Royal Belfast Hospital For Sick Children, Northern Ireland.
Insights
Gastro-oesophageal reflux monitoring in children using pH monitoring is often difficult. This study shows that pH monitoring performed under general anaesthesia provides representative data, improving patient tolerance.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Procedures
Background:
- Gastro-oesophageal reflux (GER) diagnosis often involves endoscopy and pH monitoring.
- Current pH probe placement in awake children is poorly tolerated.
- The impact of general anaesthesia on pH monitoring accuracy is unknown.
Purpose of the Study:
- To determine if pH monitoring in anesthetized children yields representative results.
- To assess the feasibility and accuracy of pH monitoring during general anaesthesia for GER investigation.
Main Methods:
- Twenty children (4 months–13 years) underwent oesophago-gastroduodenoscopy with pH electrode placement under direct vision during general anaesthesia.
- pH monitoring was conducted for 18–24 hours post-anaesthesia.
- The study was repeated within 14 days without anaesthesia for comparison.
Main Results:
- Reproducibility for key pH parameters (percent pH < 4, reflux episodes/hour, reflux duration) ranged from 75% to 90%.
- These results are comparable to studies in adults and children without anaesthesia.
- Data collected within 24 hours of endoscopy under general anaesthesia were found to be representative.
Conclusions:
- pH monitoring in children under general anaesthesia is a viable and representative method for diagnosing gastro-oesophageal reflux.
- This approach may improve patient tolerance compared to awake probe placement.
- Findings support the use of anaesthesia-assisted pH monitoring for accurate GER assessment.
Abstract:
Investigation of gastro-oesophageal reflux often includes endoscopy, usually under general anaesthesia, and pH monitoring. In most cases, the pH probe is passed when the child is awake and is poorly tolerated. The effect of general anaesthesia on pH monitoring is unknown. The aim of the study was to determine if placing the probe in the anaesthetised child gives a representative pH study. Twenty children aged 4 months to 13 years underwent oesophago-gastroduodenoscopy under general anaesthesia. A pH electrode was placed under direct vision in the distal oesophagus. pH monitoring was begun after completion of anaesthesia and continued for 18-24 hours. The study was repeated within 14 days without anaesthetic. The reproducibility of values of percent pH < 4, number of reflux episodes/hour, reflux episodes lasting > 5 min, and longest reflux episode was 85%, 90%, 75%, and 75% respectively. These results are comparable with those in adults and children in whom pH studies were performed on consecutive days (without anaesthetic) keeping all variables constant. Therefore pH data collected in a child within 24 hours of endoscopy under general anaesthesia are representative.