Abstract
Diagnosis of gastro-oesophageal reflux disease (GORD) in children with chronic neurological impairment (NI) remains a clinical challenge. The study aimed to validate the relevance of the reference values used to assess gastro-oesophageal reflux (GOR) in children with NI and to determine the optimal cut-off level of the pH-impedance parameter with the best predictive value for outcomes associated with endoscopic assessments of the oesophagus. Sixty-seven children (32 male, 35 female; age: interquartile range, 5 years 6 months–14 years 10 months; median, 11 years 3 months) with NI were prospectively recruited for the study. The exclusion criteria were previous fundoplication and lack of consent for the study. All patients underwent evaluations for GOR disease, including pH-impedance and gastroscopy. Based on endoscopy, oesophagitis was diagnosed in 22/67 children (32.8%); 9/67 (13.4%) were classified as having Hetzel–Dent grade III or IV. GOR was present in 18/67 children (26.9%), as determined by pH-impedance. Patients with endoscopic lesions had a significantly higher number of total reflux (p = 0.0404) and acidic episodes (p = 0.0219). The total number of reflux episodes, with a cut-off level of 44 episodes, was the pH-impedance parameter most strongly predictive of the presence of lesions in gastroscopy (specificity: 50%, sensitivity: 73%). These findings suggest that endoscopic lesions may be present in children with chronic NI with a low number of GOR episodes, as recorded by pH-impedance. The use of standardised reference norms determined for the general population may underestimate GOR episodes in this group of patients.
Highlights
Multichannel intraluminal impedance-pH (MII-pH), called pH-impedance, is a valuable diagnostic tool in the evaluation of gastro-oesophageal reflux (GOR) disease (GORD) and is recommended for assessing the correlation between clinical manifestations and the physiochemical properties of reflux, in addition to investigating the role of various types of refluxes in the aetiology and pathogenesis of oesophagitis and other signs and symptoms of reflux disease [1]
We showed that the distribution of pH-impedance tracing parameters in children with chronic neurological impairment (NI) significantly differed from that in healthy adults
Our analysis has demonstrated that the MII-pH parameter that best predicts the development of erosive lesions in the oesophagus is the total number of GOR episodes detected by an impedance exceeding 44
Summary
Multichannel intraluminal impedance-pH (MII-pH), called pH-impedance, is a valuable diagnostic tool in the evaluation of gastro-oesophageal reflux (GOR) disease (GORD) and is recommended for assessing the correlation between clinical manifestations and the physiochemical properties of reflux, in addition to investigating the role of various types of refluxes in the aetiology and pathogenesis of oesophagitis and other signs and symptoms of reflux disease [1]. In children with erosive oesophagitis, the number of specific reflux types recorded using the pH-impedance method was higher than in those with non-erosive reflux disease, while the qualitative interpretation of MII-pH did not differ between the compared groups of patients [11]. These discrepancies may have resulted from having used imperfect norms
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