OP‐24 ESOPHAGEAL BASELINE IMPEDANCE IN NEUROLOGICALLY IMPAIRED CHILDREN

Abstract

Introduction:Dysphagia, feeding difficulties and gastro‐oesophageal reflux (GORD) are common complaints in neurologically impaired children. Motor pattern generators localised in the brain stem and CNS reflexes play a key role on controlling oesophageal peristalsis and lower oesophageal sphincter activity. Thus, it is not surprising that brain abnormalities may result in significant oesophageal motor dysfunction. In this prospective study we evaluated the differences in multichannel intraluminal impedance‐pH monitoring (MII‐pH monitoring) pattern between children with cerebral palsy (CP) and 2 groups of neurologically normal children with normal and abnormal MII‐pH monitoring. We mainly focused our attention on oesophageal baseline impedance (BI), which has been proposed as useful parameter in predicting GORD severity.Methods:Twenty children with CP and 40 neurologically normal children with suspected GORD underwent MII‐pH impedance. Classical MII‐pH impedance parameters as well as BI values in both proximal and distal oesophagus were analysed. MII‐pH monitoring was considered abnormal if acid exposure time (AET) was >5% and/or SAP was >95%.Results:Nine CP children had a diagnosis of GORD. Of neurologically normal children, 20 had an abnormal (GR‐A) and 20 a normal MII‐pH monitoring (GR‐B). A significant difference in the proportion of children with abnormal AET was found between CP and GR‐A (9/20 vs 17/20; p < 0.05). GR‐A showed a significantly greater percentage of AET (15.97 [6.4–34.9]) than both CP (8.21 [0–31.9], p < 0.05) and GR‐B (1.4, [0–4.5], p < 0.0001), whereas between the latter groups CP showed a greater AET (p < 0.05). Proximal BI values were significantly lower in CP (1759 [691–3133]Ω) than GR‐A (2396 [1080–3850]Ω, p < 0.05) and GR‐B (3385 [2249–4817]Ω, p < 0.0001). No difference in distal BI was found between in CP (1106 [279–3098]Ω) and GR‐A (1152 [246–2526]Ω), while was lower in CP than in GR‐B (2965 [1986–3984]Ω, p < 0.001). Considering all patients as a whole group, an inverse correlation was found between distal BI and AET (r‐0.66; p < 0.001), whereas within groups an inverse correlation was only confirmed in GR‐A pts (r‐0.67; p < 0.001).Conclusions:Although an abnormal pH‐impedance monitoring was detected in almost half of children with CP, no correlation was found between the AET and BI values, suggesting that the latter cannot be used as predictor of reflux severity in this group of patients. The presence of low impedance values in both proximal and distal oesophagus in children with CP supports the view that in neurologically impaired children BI mainly reflects oesophageal motor abnormalities, which have been previously reported.