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Reliability of short-term esophageal pH monitoring versus 24-hour study
A Barabino1, M Costantini, M O Ciccone
1Department of Pediatrics, G. Gaslini Institute, Genoa, Italy.
Insights
Short esophageal pH monitoring is less reliable for diagnosing gastroesophageal reflux (GER) disease in infants and children with vomiting and respiratory issues. Prolonged 24-hour testing remains more accurate for these pediatric cases.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Accuracy
- Reflux Monitoring
Background:
- Prolonged esophageal pH monitoring for gastroesophageal reflux (GER) disease presents challenges including patient discomfort and hospitalization costs.
- Accurate diagnosis of GER disease in children is crucial for effective management and preventing complications.
- Alternative, shorter monitoring methods are sought to improve patient experience and reduce healthcare expenses.
Purpose of the Study:
- To evaluate the reliability of short-term (6-hour) esophageal pH monitoring compared to 24-hour testing in pediatric patients.
- To assess diagnostic accuracy across different age groups and clinical presentations suggestive of GER disease.
Main Methods:
- Retrospective review of 160 pediatric patients undergoing 24-hour esophageal pH monitoring.
- Comparison of a 6-hour diurnal recording (including 2 hours post-meal) against the full 24-hour recording.
- Analysis of reflux index (RI) and reflux/hour, with age-specific positive thresholds (RI >10% for <1 year, RI >5% for others).
Main Results:
- Negative predictive values for short recording RI ranged from 71% to 90%.
- Positive predictive values varied from 50% to 83%, showing unreliability in children under 12 months (50%) and those with emesis plus respiratory problems (64%).
- Agreement between short and 24-hour recordings was inconsistent, particularly for absolute RI values and in younger children.
Conclusions:
- Short-term esophageal pH monitoring demonstrates limited reliability for diagnosing GER disease in pediatric populations, especially in infants and those with complex symptoms.
- The findings suggest that 24-hour monitoring is more dependable for accurate GER diagnosis in these specific pediatric groups.
- Further research may be needed to refine short monitoring protocols or identify alternative diagnostic tools for pediatric GER disease.
Abstract:
The child's discomfort and the cost of overnight hospitalization are clear disadvantages of prolonged esophageal pH monitoring. The aim of this study was to verify the reliability of short recording versus 24-h testing in a pediatric series with symptoms suggestive of gastroesophageal reflux (GER) disease. A 24-h pH monitoring performed on 160 patients with either gastroenterological symptoms (n = 61), respiratory problems (n = 58), or emesis plus respiratory problems (n = 41) was reviewed. Regardless of clinical presentation, children were also classified according to age: < 12 months (n = 39), 12-71 months (n = 81), and 72-168 months (n = 40). A diurnal fraction of 6 h, including at least 2 h after a meal, was compared to the entire 24-h recording in all groups with respect to the reflux index (RI) (sum of the periods with pH < 3.9 expressed as percentage of time) and reflux/h. RIs of > 10% were considered positive in patients < 1 year of age, whereas RIs of > 5% were considered positive in other age groups. Negative predictive values of the short recording RI ranged from 71 to 90%. Positive predictive values ranged from 50 to 83%; it was unreliable for children < 12 mos (50%) and patients with emesis plus respiratory problems (64%), who were, significantly, the youngest. Reflux/h values were not in agreement for the same groups. Absence of agreement was found if the absolute value of RI was considered.(ABSTRACT TRUNCATED AT 250 WORDS)