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[Gastroesophageal reflux in infants: ultrasonographic reading of pHmetry]
1Service de radiopédiatrie, American Memorial Hospital, Reims, France.
Insights
Ultrasonography enhances pH monitoring for infant reflux detection by clarifying pH curve interpretations and identifying specific risks. This combined approach improves understanding of reflux events in infants.
Area of Science:
- Gastroenterology
- Pediatrics
- Medical Imaging
Background:
- Esophageal pH monitoring is sensitive for reflux but has limitations, including temporal pH changes and alkaline reflux.
- Simultaneous ultrasonography can aid in interpreting pH monitoring results.
Purpose of the Study:
- To evaluate the utility of combined pH monitoring and ultrasonography in infants with reflux symptoms.
- To improve the interpretation of reflux events in infants.
Main Methods:
- 1000 infants (80% <1 year) were studied, including those with vomiting, life-threatening events, respiratory diseases, and controls.
- pH monitoring and ultrasonography were performed before and after feeding (milk or orange juice).
Main Results:
- Ultrasonography helped interpret pH curve phases based on patient age, meals, and physiological events.
- pH monitoring identified 1589 acid reflux episodes but missed 2091 potential reflux events.
Conclusions:
- Ultrasonography defines reflux risk by assessing specificity and potential laryngeal or esophageal dysfunction.
- The combination of pH monitoring and ultrasonography improves the understanding of reflux-related events in infants, such as apnea and bradycardia.
Background:
pH monitoring of the distal esophagus has proved both sensitive and specific in the detection of reflux but has several limitations due to changes over time in esophageal pH and possibility of alkaline reflux. Simultaneous ultrasonographic monitoring can be helpful when interpreting the results.
Population And Methods:
One thousand infants (80% under 1 year of age) were examined: 500 suffered from vomiting (310 patients), life-threatening events (65 patients) or repeated respiratory diseases (125 patients). Five hundred infants were controls (320 asymptomatic and 180 sibs of patients with SIDS). pHmonitoring and ultrasonography were performed before and after ingestion of milk by vomiting patients and after administration of orange juice in the other symptomatic patients. Control patients were given milk when asymptomatic or orange juice when they belonged to a SIDS sibship.
Results:
Ultrasonography permitted to interpret the different phases of the pH curves according to the age of patients, the meals and their nature, the events associated with temporary increase in abdominal pressure, the gravity. pH monitoring was able to recognize 1589 acid reflux but failed to recognize 2091 reflux episodes.
Conclusions:
While pHmonitoring is helpful to demonstrate a relationship between the reflux and such events as apnea, bradycardia, cough, ultrasonography defines a risk based on specificity of reflux and laryngeal or esophageal dysfunction.
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