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Abbreviated oesophageal pH monitoring in infants
Y Vandenplas1, A Casteels, M Naert
1Academic Children's Hospital, Free University of Brussels, Belgium.
Insights
Twenty-four hour esophageal pH monitoring in infants shows that while 12-hour tests correlate well, 24-hour monitoring provides the most reliable gastroesophageal reflux diagnosis.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Medicine
Background:
- Gastroesophageal reflux is common in infants.
- Accurate diagnosis relies on objective measurements like esophageal pH monitoring.
Purpose of the Study:
- To compare the reliability of 24-hour esophageal pH monitoring with shorter durations (3-12 hours) in infants.
- To determine the optimal duration for accurate reflux index assessment in infants aged 6-10 weeks.
Main Methods:
- Esophageal pH monitoring was performed in 129 infants aged 6-10 weeks.
- Data from 24-hour monitoring was compared to shorter intervals (3, 6, 9, and 12 hours).
- Reflux index (percentage of time with pH < 4.0) was the primary metric.
Main Results:
- No significant difference in reflux index was found between 12-hour and 24-hour monitoring periods.
- An excellent correlation (r=0.95) existed between 12-hour and 24-hour reflux index values.
- However, a notable percentage of infants showed intra-individual differences exceeding 5-10% between 12 and 24 hours, potentially affecting interpretation.
Conclusions:
- While 12-hour monitoring shows good correlation, 24-hour esophageal pH monitoring provides the most reliable results for diagnosing gastroesophageal reflux in this infant population.
- Interrupting monitoring after 12 hours may be acceptable if necessary, but carries a risk of erroneous interpretation.
- Findings are specific to infants aged 6-10 weeks and should not be extrapolated to older children.
Abstract:
The results of 24 h oesophageal pH monitoring, performed in 129 infants aged 6-10 weeks, were compared to those in the same patients after shorter periods (3, 6, 9 and 12 h). In the investigated population there was no significant difference between the reflux index (percentage of time with a pH < 4.0) after 12 or 24 h. Moreover, the correlation coefficient between the reflux index after 12 and 24 h was excellent (r 0.95). However, the intra-individual difference in reflux index after 12 and 24 h was 5% in 19% of the infants, and even exceeded 10% in more than 5% of the infants, making the interpretation of the results unreliable. Even in this particular population of infants in whom a 24-h period could be divided into almost identical periods (including a feeding and a sleeping period), 24-h registrations provided the most reliable results. However, if for some reason the investigation had to be interrupted after a minimum of 12 h, the risk for erroneous interpretation of the data appeared to be acceptable. The results of this study must not be extrapolated to older children.