Paediatric gastro-oesophageal reflux: prognostic indicators from pH monitoring

Area of Science:

• Pediatric Gastroenterology
• Diagnostic Medicine
• Reflux Monitoring

Background:

• Gastro-oesophageal reflux (GOR) is common in children.
• Accurate diagnosis and prognosis are crucial for effective management.
• Predictive markers for treatment response in GOR are needed.

Purpose of the Study:

• To evaluate the prognostic value of 24-hour pH monitoring in children with GOR.
• To identify pH monitoring thresholds that predict the need for fundoplication.
• To differentiate prognostic indicators in primary versus secondary GOR.

Main Methods:

• Retrospective review of 24-hour pH monitoring data from 57 children with GOR.
• Comparison of pH tracings between children who responded to medical treatment and those requiring fundoplication.
• Separate analysis for primary GOR and secondary GOR (due to other conditions).

Main Results:

• For primary GOR, increased daytime reflux (21% vs 7% time pH < 4) predicted fundoplication need, with 18% threshold showing 92% specificity and 70% sensitivity.
• For secondary GOR, higher nighttime reflux (29% vs 3.7% time pH < 4) predicted fundoplication, with 18% threshold showing 80% specificity and 86% sensitivity.
• A percentage time pH < 4 greater than 18% served as a useful prognostic threshold.

Conclusions:

• 24-hour pH monitoring data, both daytime and nighttime, have prognostic value in different pediatric GOR subgroups.
• Specific pH monitoring thresholds can help predict treatment outcomes and the need for surgical intervention.
• This analysis provides evidence for using pH monitoring as a predictive tool in pediatric GOR management.