Abstract
Background: Esophageal distribution and clearance of gastroesophageal reflux (GER) are considered risk factors for pathologic GER. Combined multichannel intraluminal impedance and pH (MII/pH) monitoring has been shown to be an effective approach with which to characterize acid GER (AGER) and non-acid GER (NAGER) as well as to efficiently measure the efficiency of GER volume clearance. Aims: 1) To assess the effect of pH and feeding status on GER frequency and the proximal extent of GER migration. 2) To measure the clearance of AGER and NAGER during fasting, feeding, the first post-prandial hour (1st PP), and the second post-prandial hour (2nd PP). Methods: Thirty-three children (18M/15F, mean age 7 years old) were examined over a 24 hours period using combined MII/pH. All patients were referred with clinical symptoms that were suggestive of GER as an underlying etiology. Data were analyzed using mixed models with repeated measures with significance established at P ≤ 0.05. Study protocol was approved by the Institutional Review Board at Columbus Children's Hospital in Columbus, Ohio USA. Results: Significantly more GER occurred during 1st PP (1.74 ± 0.16 GER/hr) than during fasting (0.94 ± 0.13 GER/hr), feeding (1.04 ± 0.15 GER/hr) or 2nd PP (1.36 ± 0.17 GER/hr) (p < .0001) periods. NAGER was predominant over AGER during feeding (p = .0111) and 1st PP periods (p = .067). There were no differences in the proximal migrations of AGER and NAGER (p = .5909). Significantly fewer AGER reached the proximal esophagus during feeding when compared those AGER that occurred during fasting (p < .0001), 1st PP (p = .0067), or 2nd PP (p = .0036) periods. pH had no significant influence on the efficiency of volume clearance (p = .6608). GER volume clearance was significantly prolonged during fasting (vs 1st PP, P = 0.0304). Conclusions: In symptomatic children, 1) the frequency of GER is significantly highest during 1st PP periods and lowest during fasting periods, 2) pH has no significant effect on the efficiency of GER clearance or proximal esophageal migration, and 3) GER volume clearance is least efficient during fasting periods when the frequency of GER is low and most efficient during 1st PP periods when the frequency of GER is high.
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