Abstract
BackgroundWireless pH-monitoring is an accurate method for diagnosing adults with gastroesophageal reflux disease (GERD). The aim of this study was to evaluate the use of the Bravo capsule on children investigated for GERD in terms of safety, tolerability and feasibility before and after administration of proton pump inhibitors.MethodsA Bravo capsule was inserted during upper endoscopy under general anaesthesia or deep sedation with propofol. 48-hour pH-metry was performed in 106 children (50 males, 56 females) at the median age of 11 years (range 17 months-18 years). On the second day of investigation, proton pump inhibitor (PPI) was given at a mean dose of 1.6 mg/kg (SD ±0.6 mg). The definition of GERD was set to a reflux index (RI) of ≥5% and DeMeester score (DMS) ≥14.7.ResultsApplication of the capsule was successful in 103 of the 106 children (97.2%) and interpretable in 99 of these 103 (96.1%). 49 of the children with interpretable results (49.5%) had GERD according to RI, while 51 (56.7%) had GERD according to DMS. After PPI was given on day 2, RI decreased from a median of 4.9% (range 0.3-63.4%) to 2.2% (0–58.0%), while DMS decreased from a median of 17.6 (range 2.2-207.6) to 8.2 (0.3-178.6), respectively (p < 0.0001). No severe adverse events were reported.ConclusionWireless pH-metry is a safe and tolerable method when investigating children for GERD. PPI given on the second day of assessment provides additional information on response to treatment suggesting that pH-metry preferably should be extended to 48 hours.
Highlights
Wireless pH-monitoring is an accurate method for diagnosing adults with gastroesophageal reflux disease (GERD)
Of these 104 children, 26 (25.0%) had esophagitis findings only in EGD, 9 (8.7%) had microscopical esophagitis only, 17 (16.3%) had esophagitis according to EGD that were confirmed by histology, and 52 (50%) children had normal findings with both examinations
The pH-monitoring in this study showed that 50% of the patients exceeded reflux index (RI) of 5% and 57% exceeded DeMeester score (DMS) of 14.7, so that they could successfully be treated for GERD
Summary
Wireless pH-monitoring is an accurate method for diagnosing adults with gastroesophageal reflux disease (GERD). GERD can manifest as vomiting, poor weight gain, failure to thrive, dysphagia, cough, laryngitis, and wheezing [2,3] It commonly occurs with regurgitation in healthy children from birth; only 4% of the infants have daily signs of reflux at one year of age [4]. A wireless system was developed using a capsule attached to the mucosa wall of the esophagus for electronic pH monitoring This so-called Bravo pH Monitoring System (Medtronic Inc., Minneapolis, MN) has proven to be both safe and tolerable in adults [7,8], as well as among children [9,10]. In pediatric patients suspected to have GERD of whom many may be neurologically impaired or have certain genetic disorders [11], it is even more important to provide a less disturbing method for pH-metry
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