EVALUATION OF GASTROESOPHAGEAL REFLUX IN PEDIATRIC ASTHMA PATIENTS BY INTRAESOPHAGEAL MULTICHANNEL IMPEDANCE‐PH MONITORING

Abstract

Objective: To determine the proportion of acid and nonacid reflux events in pediatric patients with asthma suspected of having gastroesophageal reflux (GER) utilizing combined multichannel intraluminal impedance and pH (MII-pH). The secondary objective was to determine the correlation of respiratory symptoms with nonacid and acid reflux events (respiratory symptom index). Methods: Prospective study of children with asthma, age five months to six years, referred by the pulmonologists to the GI department of The Children's Hospital of Denver for evaluation of GER. Exclusion criteria were congenital anomalies, cerebral palsy, mental retardation, or cardiac disease. Children were admitted to The Children's Hospital Clinical Research Center for 20-hour MII-pH study. Acid suppression was discontinued 2 weeks prior to testing. Results: 24 children (7 female/17 male) were enrolled from 3/04 to 2/05. Age range was 5-67 months (mean, 33 months). A total of 1184 reflux events was detected by combined MII-pH, while pH probe detected 419 additional events without impedance changes diagnostic of reflux. The percent of nonacid MII detected reflux events was 51% (605 events) vs. 49% (579 events) acid reflux events. The proportion of nonacid reflux events decreased with the time elapsed from the last meal (p < 0.0001 by Pearson Chi-square test). There was no association between age and the proportion of nonacid refluxes (p = 0.56). There were 555 total symptoms recorded. The most frequent symptom was cough (331 reports) 9.4% of cough episodes were associated with nonacid reflux events and 17.2% were associated with acid reflux events. Conclusion: The proportion of nonacid and acid reflux events in children with asthma is similar to adults with GER. MII-pH monitoring detects more reflux events than pH probe alone. Although combined MII-pH esophageal monitoring identifies more reflux events, it does not increase the detection of a clinical correlation of all symptoms with reflux.