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Detection of gastroesophageal reflux by electrical impedance tomography
1Gastroenterological Unit, Hospital for Sick Children, London, United Kingdom.
Insights
Electrical impedance tomography (EIT) shows promise in detecting gastroesophageal reflux (GER) in children. This non-invasive technique correlates well with traditional pH monitoring for identifying reflux events and gastric emptying abnormalities.
Area of Science:
- Pediatric Gastroenterology
- Medical Imaging Technology
- Diagnostic Techniques
Background:
- Gastroesophageal reflux (GER) and altered gastric emptying are prevalent in children with vomiting and feeding issues.
- Electrical impedance tomography (EIT) is a non-invasive imaging technique that measures regional impedance changes within the body.
Purpose of the Study:
- To evaluate the utility of EIT in assessing gastric emptying and detecting GER in pediatric patients.
- To compare EIT findings with traditional intraesophageal pH monitoring in diagnosing GER.
Main Methods:
- Simultaneous 2-hour EIT and intraesophageal pH monitoring were performed on six pediatric patients after a glucose meal.
- An in vitro tank test system was used to validate EIT's ability to detect reflux.
- Retrospective analysis of EIT and 24-hour pH monitoring data from 50 patients was conducted.
Main Results:
- EIT detected abnormalities in gastric emptying curves suggestive of GER, correlating with intragastric resistance changes.
- In vitro testing confirmed EIT's sensitivity to reflux volumes as low as 25 ml.
- A significant correlation was found between EIT-detected negative peaks and GER episodes identified by pH monitoring (sensitivity 94.6%, specificity 76.9%).
Conclusions:
- EIT is a sensitive and specific tool for detecting pathological gastroesophageal reflux in children.
- EIT offers a promising non-invasive method for evaluating gastric emptying and GER in pediatric patients.
- EIT findings correlate well with established diagnostic methods, potentially aiding in clinical decision-making.
Abstract:
In children with vomiting, dyspepsia, and feeding problems, gastroesophageal reflux (GOR) and altered gastric emptying are common. We have used electrical impedance tomography (EIT) to study children with suspected gastric emptying disorders. Abnormalities of the gastric emptying curve suggestive of GOR were seen in some, with marked negative or positive shifts related to sharp increases or decreases in intragastric resistance. These findings could represent fluid leaving or entering the stomach, as might occur in GOR. To confirm the origin of the abnormal EIT curves, we devised and in vitro tank test system, and we performed simultaneous 2-h EIT and intraoesophageal pH monitoring after a glucose meal on six patients. In vitro, reflux of > or = 25 ml produced clearly detectable changes on the emptying curves. In vivo, the overall correlation between the times of 42 GOR episodes lasting > or = 1 min detected by pH study and the times of 38 negative peaks due to > or = 15% changes of the maximum intragastric resistivity detected by simultaneous EIT was significant; the correlation was highly significant in four of six patients. When the peaks were used to define GOR episodes on EIT gastric emptying curves, the two methods still showed good agreement. Retrospective examination of 50 patients who had undergone both EIT and 24-h intraoesophageal pH study during their diagnostic workup showed that EIT had a sensitivity of 94.6% and a specificity of 76.9% (with positive and negative predictive values of 0.92 and 0.83, respectively) for the detection of pathological GOR.(ABSTRACT TRUNCATED AT 250 WORDS)