Mixed Reflux Research Articles

Microbial Community Structure for Sewage Wastewater Treatment Plants in Winter

Constructing an effective control strategy for the daily operation of sewage treatment plants daily operation is an important criterion for the removal performances of nutrient stable in winter. To investigate microbial community structure, functional groups, and relationships between population dynamics and effluent variation, activated sludge obtained from 4 plants, which were running stably in a low temperature period (8-15℃) in northern China, were sampled. The high-throughput sequencing results indicated that the microbial community had good richness in the low temperature period during which the abundance of Actinobacteria increased. Nitrosomonas, a key functional ammonia oxidation bacterium, was greatly affected by the decreasing temperature, while Denitrifies, a highly diverse core group with wide distribution, maintained stable abundance indicating less influence of decreasing temperature. The denitrification efficiency was only associated with the mixed liquor reflux ratio. Tetrasphaera was widely present in four processes and played an important role for the removal of biological phosphorus. Sludge bulking phenomena caused by filamentous bacteria overgrowth occurred frequently in winter; however the quality of effluents was slightly influenced.

The Correlation between the Characteristic of Reflux Based on 24 Hours-Multichannel Intraluminal ImpedancePh Monitoring with the Quality of Life of Refractory Laryngopharyngeal Reflux Patients

The evaluation of the quality of life of LPR patients is crucial to assess the success of medical therapy and help with diagnosis. Assessment of life quality of patients with refsractory LPR by using the selected LPR HRQL questionnaire because it is more practical to use, easy to set scoring and analyze data. Objective: This study aims at investigating the reflux characteristic and the correlation with refractory Laryngopharyngeal Reflux (LPR) patients quality of life. Method: The examination is performed on ten refractory LPR patients using 24hour - MultichanneI Intraluminal Impedance pH monitoring, then grouped according to the characteristics of the reflux acid, non-acidic, and mixed. Furthermore, the assessment of life quality by using LPR-HRQL questionnaire. Data analysis using Chi-Square and Spearman’s Rho methods. Results: The sampleLPR refractory is generally female (66.7%), while males (33.3%). Mixed reflux type as much as 44.4%, then 33.3% acid reflux, and a non-acidic reflux 22.2%. LPR occurrence of majority at upright position (66.7%). Non-acid reflux patients consistently for all symptoms/complaints, indicating quality of life is disrupted based on questionnaires found in the LPR-HRQL (100%). Conclusion: The quality of life of non-acid reflux patients is more disturbed than the acidic and mixed reflux group.

Involvement of Laryngopharyngeal Reflux in Select Nonfunctional Laryngeal Diseases: A Systematic Review.

To investigate the existing published evidence supporting the role of laryngopharyngeal reflux (LPR) in the development of the select nonfunctional laryngeal diseases of laryngotracheal stenosis, granuloma, leukoplakia, and laryngeal infections. PubMed, Cochrane Library, and Scopus. A systematic review was performed by 3 independent investigators for studies providing information about the prevalence and role of LPR in the development of laryngotracheal stenosis, granuloma, leukoplakia, and laryngeal infections. Diagnostic criteria and clinical outcome evaluation of included studies were analyzed with PRISMA criteria. Of the 64 relevant publications, 27 clinical and 4 basic science studies were included. Ten studies used objective reliable examinations for LPR diagnosis (eg, dual- or triple-probe or oropharyngeal pH monitoring, multichannel intraluminal impedance-pH monitoring, or pepsin detection). According to the bias analysis and the results of studies, the association between LPR and laryngotracheal stenosis, leukoplakia, laryngeal papillomatosis, or vocal fold granuloma remains poorly demonstrated. There is a notable heterogeneity among included studies regarding their inclusion criteria, diagnostic methods, and clinical outcome evaluation. Although some experimental findings support the involvement of bile salts and other gastroduodenal proteins active in alkaline pH, no included clinical studies assessed the role of nonacid and mixed reflux through multichannel intraluminal impedance-pH monitoring. The involvement of LPR in the development of leukoplakia, laryngotracheal stenosis, vocal fold granuloma, and laryngeal papillomatosis is currently not demonstrated. The potential relationship between LPR and these select nonfunctional laryngeal diseases must be confirmed through future clinical and experimental studies considering acid, nonacid, and mixed LPR.

Gastro‐esophageal Reflux After Laparoscopic Gastrostomy Placement in Children

Gastrostomy placement is frequently performed in pediatric patients who require long-term enteral tube feeding. Evidence on the influence of gastrostomy placement on gastro-oesophageal reflux disease has been inconsistent. The aim of this study was to investigate the influence of gastrostomy on gastro-oesophageal reflux. A prospective, longitudinal cohort study was performed including 50 patients who underwent laparoscopic gastrostomy between May 2012 and April 2014. Before and 3 months after surgery 24-hour multichannel intraluminal impedance pH monitoring was performed and caregivers filled out reflux symptom questionnaires. Gastro-oesophageal reflux symptoms were present in a comparable number of patients before (44%) and after gastrostomy placement (40%; P = 0.73). Twenty-five of the patients (50%) underwent both the preoperative and postoperative tests and were included in impedance-pH analysis. Acid exposure time (percentage of time with pH below 4) did not change significantly after gastrostomy placement: from 6.2% (3.0-18.1) to 6.1% (2.6-14.9). The number of reflux episodes did not significantly change, for either liquid [mean difference 4.3 (-4.5 to 13.2)] or mixed liquid-gas reflux [mean difference 2.0 (-9.3 to 13.3)]. Before gastrostomy placement, 18 out of 25 patients had pathological reflux (72%) on pH-impedance measurement. In 4 patients, pathological reflux dissolved, whereas 4 patients newly developed pathological reflux. A low preoperative weight-for-height percentile was associated with increased acid exposure after gastrostomy placement. Overall, gastrostomy placement was not associated with an increase in acid exposure on 24-hour multichannel intraluminal impedance pH monitoring. Similarly, the prevalence of gastro-oesophageal reflux-related symptoms did not change after gastrostomy.

Etiological involvement of weak acid reflux in the development of esophageal carcinoma.

435 Background: Patients with gastroesophageal reflux disease (GERD) with mixed gastric acid–bile acid reflux are at a high risk of developing reflux-induced esophageal cancer. Increased local production of prostaglandin E2 (PGE2) is etiologically associated with reflux-induced esophageal cancer pathogenesis; however, the underlying mechanism remains unclear. Our aim was to investigate the relationship between PGE2 production in esophageal cells and reflux fluids, particularly gastric acid. The effect of the Kampo medicine Hangeshashinto (HST), which reduced the incidence of reflux-induced esophageal cancer in rats (Surgery 2018), on PGE2 production was also examined. Methods: Esophageal squamous cell carcinoma were treated for 2 h with acidic culture condition (pH 3.5 – 6.5) and chenodeoxycholic acid (CDCA; 200, 400 μmol/L), followed by measurement of PGE2 production in the culture medium for the additional 6 h by enzyme-linked immunosorbent assay. Results: CDCA induced PGE2 production and significantly increased cyclooxygenase-2 (cox-2) expression. However, in weak acidic conditions (pH 4–5), a pH-specific and significant increase in PGE2 production with no increase in cox-2 expression was observed. cPLA2 inhibitor decreased the effect of weak acid stimulation, indicating that the mechanism underlying PGE2 production differs between weak acid and CDCA. In addition, HST significantly inhibited both weak acid- and CDCA-induced PGE2 production. Conclusions: The synergistic effect of bile acid-induced cox-2 expression and weak acid-induced arachidonic acid production via cPLA2 can cause excessive PGE2 production. Therefore, mixed reflux showing pH 4–5 could contribute to the high incidence of esophageal cancer, which might be prevented by HST treatment. Weak acid reflux around pH 4–5 has been observed in PPI-treated patients, who could exhibit excessive PGE2 production as well as increased risk of reflux-induced esophageal cancer.

PECULIARITIES OF THE COURSE AND TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE IN PATIENTS WITH SYNDROME OF UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA. (SYSTEMATIC LITERATURE REVIEW)

PECULIARITIES OF THE COURSE AND TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE IN PATIENTS WITH SYNDROME OF UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA. (SYSTEMATIC LITERATURE REVIEW)

Condition of nasopharynx contamination in children with chronic tonsillitis and gastroesophageal reflux disease

The aim was to study the condition of nasopharynx contamination in children with chronic tonsillitis depending on the presence of pathological gastro-esophageal reflux.Materials and methods. In total, 44 children aged 4.60 ± 0.14 years were enrolled in the study. The index group comprised 22 people with chronic tonsillitis and gastroesophageal reflux disease (GERD); the control group consisted of 22 people with chronic tonsillitis but without GERD. Samples of nasopharynx secretion (pharyngeal and nasal swabs) were taken for culture and their results were analyzed. The results were statistically processed with the use of Microsoft Office Excel and Statistica 13 software.Results. It was found that pharyngeal cultures obtained from children of the index group tended to reveal H. influenzae in the swab more frequently (in 77.3 %, P = 0.06). This microorganism was revealed in nasal cultures of children with GERD (in 31.8 %, P = 0.02) and only in mixed and acid reflux (30.0 % and 80.0 %, respectively). 63.6 % of children from the index group were culture positive for more than two microorganisms, which was typical for half of the children with mixed and acid reflux (13.6 %, P = 0.002). It was defined that children with GERD and colonized by H. influenzae, demonstrated higher rates of total quantity of acid reflux (193.86 ± 40.46 compared to 104.80 ± 2.06, P = 0.05), persistent acid reflux (7.50 ± 1.62 compared to 3.67 ± 1.20, P = 0.04), as well as percentage of acid reflux per day (26.17 ± 7.23 compared to 7.44 ± 2.06, P = 0.004).Conclusions. Contamination of pharyngeal and nasal mucous membranes in children with GERD and chronic tonsillitis was represented by potentially pathogenic bacterial microflora (in 95.5 %) with the prevalence of H. influenzae. More than two microorganisms were revealed in children with mixed and acid reflux (P = 0.05). Children with GERD and chronic tonsillitis, provided H. influenzae colonization, demonstrated higher rates of total quantity of acid reflux (P = 0.05), persistent acid reflux (P = 0.04), as well as percentage of acid reflux per day (P = 0.004).

Evaluation of Noncardiac Chest Pain (NCCP) in Iranian Patients with Nonerosive Reflux Disease (NERD) based on 24-Hour Multichannel Intraluminal Impedance-pH (MII-PH) Monitoring Tests

Background/Aims: The noncardiac chest pain (NCCP) remains a challenge in diagnosis and management. This symptom has a different etiology but suggests that gastroesophageal disease is the most common of NCCP. Method: This study was conducted on 715 participants aged 11 to 63 years, with the chief complaint of regurgitation and NCCP. The esophageal manometry and multichannel intraluminal impedance-pH (MIIPH) monitoring tests were performed based on off proton pump inhibitors therapy in all patients. Results: The NCCP was more prevalent in males (61.5%) than in females (38.5%) and more prevalent in patients younger than 50 years (69.1%). The mean DeMeester score value was higher in NCCP group (45.5±10.8). Of the patients with NCCP, 41.4% showed a pathological esophageal acid exposure time (EAET). Moreover, acid (24.7%), gas (45.8%) and mixed reflux episodes (55.6%) were more prevalent in patients with NCCP in supine position than those with regurgitation. Conclusions: The present study revealed that acid, gas, and mixed reflux episodes were more prevalent in patients with noncardiac chest pain (NCCP) than those with regurgitation, mostly in supine position, however, the differences were not significant between the 2 groups (p>0.05). Furthermore, NCCP was more prevalent in males and patients younger than 50 years.

Laryngopharyngeal reflux disease: clinical presentation, diagnosis and therapeutic challenges in 2018.

To review the recent literature on presentation, diagnosis and treatment of laryngopharyngeal reflux. Patients with laryngopharyngeal reflux have a higher risk for gastroesophageal reflux and respiratory-related diseases. Many symptoms and findings are underestimated, contributing to the inconclusive results of many therapeutic trials. Additionally, little significance is given to nonacid and mixed refluxates, although a significant prevalence. The association between symptoms, signs, impedance-pH studies and pepsin detection could be the most accurate way for a clear diagnosis. 'Reflux profiling' is also important for the administration of a personalized treatment based on diet, proton pump inhibitors, alginate, magaldrate and other second-line drugs. There are only a handful of studies focusing on the addition of alginate or magaldrate to the treatment of laryngopharyngeal reflux, although their contribution has extensively been demonstrated. Diagnosis remains controversial despite improvement in impedance and availability of pepsin detection in daily practice. With recent studies exhibiting a significant prevalence of nonacid or mixed refluxes, the addition of alginate or magaldrate to proton pump inhibitors should be considered. Future studies are needed to assess these new therapeutic schemes in moderate and severe laryngopharyngeal reflux.

Therapy for erosive esophagitis induced by mixed reflux in patients with CAD

The article presents the results of using a combination of PPI (pantoprazole) and UDCA for the treatment of erosive esophagitis induced by mixed reflux in patients with coronary artery disease.A total of 62 patients with EGDS-proven erosive esophagitis were enrolled in the study. The patients were divided into two groups: the active treatment group (ATG) which included 34 patients with erosive reflux esophagitis and control group (CG), which included 28 patients with erosive reflux esophagitis without CAD. The patients of both groups received IPP (pantoprazole) 80 mg/day and UDCA at a dosage of 15 mg/kg/day for 12 weeks. (84 days).The study showed that complete epithelialization of esophageal mucosa defects was detected in 100% of ATG patients by Day 84 of therapy, the same was achieved in CG patients by Day 56 of the basic course of therapy.The treatment of EE induced by mixed reflux with a combination of PPI (pantoprazole) at a dose of 80 mg/day and UDCA at a dosage of 15 mg/kg/day was efficient in patients with GERD and CAD as a basic course of therapy for not less than 84 days. An effective dose of UDCA for maintenance therapy is 5 mg/kg/day in combination with PPI at a daily dose of 40 mg for not less than 2 months.

Reflux and Belching after Laparoscopic 270 degree Posterior Versus 180 degree Anterior Partial Fundoplication

BackgroundLaparoscopic 270 degree posterior, or Toupet (LTF), and 180 degree anterior partial fundoplication (LAF) ensure equal reflux control and reduce the risk of gas-related symptoms compared to 360 degree (Nissen) fundoplication. It is unclear which type of partial fundoplication is superior in preventing gas-related side-effects. The aim of this study was to determine differences in effect of LTF and LAF on reflux characteristics and belching patterns. MethodsUpper gastrointestinal endoscopy, esophageal manometry, and 24-h combined pH-impedance monitoring were performed before and 6 months after fundoplication (n = 10, LTF vs. n = 10, LAF). Observed changes after surgery (∆) were compared between the two procedures. ResultsSymptomatic reflux control as well as the reduction in the mean number of acid (∆ − 58.5 vs. − 66.5; P = 0.912), liquid (∆ − 17.0 vs. − 43.5; P = 0.247), and mixed liquid gas reflux episodes (∆ − 38.0 vs. − 40.0; P = 0.579) were comparable following LTF and LAF. There were no differences in the mean number of weakly acidic reflux episodes after LTF and LAF (1.0 (0.8–4) vs. 1.0 (0–3), P = 0.436). The reduction in proximal (P = 1.000), mid-esophageal (P = 0.063), and distal reflux episodes (P = 0.315) was comparable. Both procedures equally reduced the number of gastric belches (P = 0.278) and supragastric belches (P = 0.123), with no significant reduction in the number of air swallows after either procedure (P = 0.278). ConclusionLTF and LAF provide similar reflux control, with a comparable effect on acidic, liquid, and gas reflux. Both procedures equally reduced the number of belches and supragastric belches. This study provides the physiological evidence for the published randomized trials reporting similar symptomatic outcome after both types of partial fundoplication.

Gastroesophageal Reflux Characteristics and Patterns in Patients with Idiopathic Subglottic Stenosis.

Introduction Idiopathic subglottic stenosis represents a spectrum of subglottic disease without a clear underlying cause. Prior studies have implicated a pathogenic role of gastroesophageal reflux disease in idiopathic subglottic stenosis. The aim of this study was to examine the presence and pattern of gastroesophageal reflux in a large cohort of patients with idiopathic subglottic stenosis at a tertiary referral center. Methods We performed a retrospective review of patients with idiopathic subglottic stenosis from January 2010 to December 2016 who had undergone combined pH impedance testing. Patients with prior gastric or esophageal surgery were excluded. Data obtained included esophageal acid exposure times, number of reflux events, patient position during reflux events (defined as upright, supine, or mixed), body mass index, and the presence of proton pump inhibitor therapy. Results 159 patients with the idiopathic subglottic stenosis were identified, of whom 41 had undergone esophageal pH impedance testing. 40 (97.6%) were women, with a mean age of 54.8 (range 31–79) years and BMI of 31.0 (range 17–55). Overall, 19 (46.3%) patients were found to reflux as confirmed by abnormal esophageal acid exposure or abnormal number of reflux events. 15 of the 19 patients with reflux had predominantly upright gastroesophageal reflux disease, whereas 2 had supine and 2 mixed reflux. Discussion In patients with idiopathic subglottic stenosis who underwent evaluation by combined pH impedance, close to half were found to have gastroesophageal reflux disease. The majority of gastroesophageal reflux occurred while the patients were in the upright position.

THE ROLE OF PEPSINOGENES AND SOME INTESTINAL HORMONES IN PATHOGENESIS OF GASTROESOPHAGEAL REFLUX DISEASE

80 patients with gastroesophageal reflux disease (GERD) were examined. The diagnosis of GERD was based on the history of the disease, complaints of patients, the results of daily monitoring of pH in the lower third of the esophagus, data of fibroesophagogastroduodenoscopy, chromoendoscopy, 13C-octanoic breath test, gastrin-17 (G-17) concentration, pepsinogens I and II (P I and II) and cholecystokinin-pancreozymin (C-P) in serum. After 24 hours pH monitoring of the lower third of the esophagus in 40 patients with GERD, the predominance of acid was found, and the other 40 patients had mixed refluxes. In patients with predominance of acid reflux, the mean values of half-life of solid food evaluation (T1/2) according to 13C-octanoic breath test was (45.25±1.34) min. With the predominance of mixed refluxes in patients, there was a tendency towards hypokinetic motility of the stomach, indicating a slowdown in half-life of solid food evaluation from the stomach up to (139.24±11.87) min. With the predominance of acid reflux also was observed a significant reduction in the concentration of G-17 and C-P, an increase in P I and a decrease in the concentration of P II. Hypergastrinemia, high levels of C-P and P II (37.44±3.41) μg/l (p<0,05) were diagnosed with the predominance of mixed refluxes.

Gastro-pharyngeal reflux and total laryngectomy. Increasing knowledge about its management

PurposeInvestigate the incidence, the degree and the effect of gastro-pharyngeal reflux (GPR) in laryngectomised patients. Materials and methodsBehavioral and 24-hour pH- and impedance-monitoring data were prospectively analyzed for 25 laryngectomised patients with no previous history of GER in outpateints' setting. Reflux detected was characterized as either acid, weakly acidic or nonacid. Proximal reflux was found at 15cm above the LES. Results40% of patients presented a pathological number of reflux episodes in the upright position (p<0.0001); 9 of them presented a pathologic bolus exposure time. Bolus exposure at the proximal sphincter was one fourth-fold lower than 5cm above the LES (p=0.3593). There was a prevalence of acid reflux at both sphincters (p<0.0001); liquid reflux was prevalent at the LES (p=0.003) and mixed reflux at the UES (p=0.0001). Median REs was higher than time acid exposure (p=0.0013). ConclusionsPre- and post-surgical reflux investigation could identify preexisting reflux severity and screen potential high-risk cancer patients for postoperative complications. This might allow the early onset of acid suppressive therapy in presence of pathologic findings in high-complication risk cancer patients.

Comparison of Characteristics According to Reflux Type in Patients With Laryngopharyngeal Reflux

Objectives To analyze laryngopharyngeal reflux (LPR) as an acidic, nonacidic, or mixed type according to 24-hour multi-channel intraluminal impedance (MII) pH monitoring and the clinical characteristics of each type.Methods Ninety patients were prospectively enrolled in this study. All patients underwent 24-hour MII pH monitoring as a diagnostic tool. Eighty-three patients were diagnosed with LPR. The patients were classified into three groups according to the pH of the hypopharyngeal probe: the acid reflux group, nonacid reflux group, and mixed reflux group. Subjective symptoms and objective findings were evaluated based on patients’ responses to the Short Form 12 Survey (SF-12), LPR health-related quality of life (LPR-HRQOL), reflux symptom index, and reflux finding score.Results The results of each group were compared. As a result, 34 patients were classified into the nonacid reflux group and 49 into the mixed reflux group. There were no patients classified as having acid reflux alone. There was no significant difference between the two groups when comparing the reflux symptom index, reflux finding score, LPR-HRQOL, or the mental component score of the SF-12. However, the physical component score of the SF-12 was higher in the nonacid reflux group (P=0.018). The DeMeester composite score (P=0.015) and total number of LPR events (P=0.001) were lower in the nonacid reflux group than in the mixed reflux group.Conclusion In conclusion, no LPR patient had only acid reflux. The nonacid reflux LPR patients showed similar clinical characteristics and findings compared to the mixed reflux group, but exhibited significantly fewer LPR episodes.

COMBINATION THERAPY OF EROSIVE FORM OF GERD IN PATIENTS WITH THE MIXED CHARACTER OF RELUCTATE

The article presents the result of study of the effectiveness of a new drug dexlansoprazole in combination with the drug ursodeoxycholic acid in the group of patients with erosive esophagitis, with mixed reflux, as defined by results of 24-hour pHimpedance metering. Dynamics of clinical symptoms and endoscopic pattern when taking different doses of UDCA of primary and supportive therapy is monitored.

Liquid-containing Refluxes and Acid Refluxes May Be Less Frequent in the Japanese Population Than in Other Populations: Normal Values of 24- hour Esophageal Impedance and pH Monitoring.

Background/AimsTwenty-four-hour esophageal impedance and pH monitoring allows detection of all types of reflux episodes and is considered the best technique for identifying gastroesophageal refluxes. However, normative data for the Japanese population are lacking. This multicenter study aimed to establish the normal range of 24-hour esophageal impedance and pH data both in the distal and the proximal esophagus in Japanese subjects.MethodsForty-two healthy volunteers (25 men and 17 women) with a mean ± standard deviation age of 33.3 ± 12.4 years (range: 22–72 years) underwent a combined 24-hour esophageal impedance and pH monitoring. According to the physical and pH properties, distal or proximal esophageal reflux events were categorized.ResultsMedian 45 reflux events occurred in 24 hours, and the 95th percentile was 85 events. Unlike previous reports, liquid-containing reflux events are median 25/24 hours with the 95th percentile of 62/24 hours. Acidic reflux events were median 11/24 hours with the 95th percentile of 39/24 hours. Non-acidic gas reflux events were median 15/24 hours with the 95th percentile of 39/24 hours. Proximal reflux events accounted for 80% of the total reflux events and were mainly non-acidic gas refluxes. About 19% of liquid and mixed refluxes reached the proximal esophagus.ConclusionsUnlike previous studies, liquid-containing and acidic reflux events may be less frequent in the Japanese population. Non-acidic gas reflux events may be frequent and a cause of frequent proximal reflux events. This study provides important normative data for 24-hour impedance and pH monitoring in both the distal and the proximal esophagus in the Japanese population.

Role of Mixed Reflux and Hypomotility with Delayed Reflux Clearance in Patients with Non-cardiac Chest Pain.

Background/AimsGastroesophageal reflux disease (GERD) is the most common cause of non-cardiac chest pain (NCCP). Currently available data reveal a weak relationship between NCCP and dysmotility. Moreover, it is unclear why some refluxes are perceived as heartburn and others as NCCP. We aimed to evaluate the role of the reflux pattern and the esophageal motility in patients with NCCP.MethodsForty-eight patients with NCCP (Group 1) and 50 only typical GERD symptoms (Group 2) were included and underwent high-resolution manometry (HRM) and multichannel intraluminal impedance-pH monitoring.ResultsImpaired peristalsis was found in 60% of patients with NCCP and in 24% of patients with typical symptoms (P < 0.05). In patients belonging to Group 1, the majority of reflux episodes associated with chest pain were acid and mixed. The proportion of mixed refluxes was higher than that in Group 2. In Group 1, the reflux clearing time at 5, 9, and 15 cm, measured in reflux episodes associated to NCCP was longer than in reflux episodes associated to typical symptoms (mean ± 95% CI: 27.2 ± 5.6, 23.3 ± 4.4, and 14.6 ± 2.3 seconds vs 18.3 ± 3.5, 13.3 ± 2.2, and 11.1 ± 1.8 seconds; P < 0.01).ConclusionsThe presence of gas in the refluxate seems to be associated with NCCP. The impaired motility observed in NCCP patients may play a relevant role in delaying reflux clearing, hence increasing the time of contact between refluxate and esophageal mucosa.

The Correlation between Endoscopic Reflux Esophagitis and Combined Multichannel Intraluminal Impedance-pH Monitoring in Children

Gastroesophageal reflux (GER) is the retrograde flow of gastric contents into the esophagus and may induce a variety of complications. Endoscopically visible breaks in the distal esophageal mucosa are the most reliable evidence of reflux esophagitis. Combined multichannel intraluminal impedance and pH-metry (MII-pH) is a technique that enables monitoring of GER independent of its acidity. The aim of this study is to investigate the GER patterns in children with the aid of MII-pH monitoring and determine the correlation between endoscopically proven reflux esophagitis and reflux types by MII-pH monitoring. One hundred and twenty children were enrolled from January 2010 to October 2011 for MII-pH monitoring. We studied the GER patterns by means of pH (acid and nonacid reflux) and composition (liquid, mixed, and gas reflux) by the esophageal MII-pH signals. Meanwhile, 34 (28.3%) patients received esophagogastroduodenoscopy examination at the same time. The severity of reflux esophagitis was graded with Los Angeles classification. MII-pH monitoring significantly increased the detection of numbers of reflux compared with traditional 24-hour pH monitoring (p<0.001). The significant cutoff value of MII-pH parameters including DeMeester score ≥ 21, duration of longest acid reflux ≥ 17minutes, and occurrence of acid reflux for more than 5minutes showed good correlation in the prediction of the presence of endoscopic reflux esophagitis. The odds ratios of the above mentioned parameters were 12.6, 8.94, and 7.5, respectively (p=0.02, p=0.01, and p=0.01). Furthermore, ≥ 3 episodes per day of acid reflux for more than 5minutes can predict the occurrence of severe reflux esophagitis (odds ratio 12.78, p=0.009). MII-pH monitoring not only raised the diagnostic yield in identifying GER, but it also showed significant correlation with the presence of endoscopically proven reflux esophagitis in children.

PP‐16 WEAK ACID REFLUX A TRIGGER FOR RECURRENT RESPIRATORY DISEASES IN CHILDREN

Introduction:The main advantage of multichannel intraluminar impedance (MII) compared with pH monitoring is its ability to detect both acid and non‐acid gastroesophageal reflux (GER) and to determine the characteristics of reflux (liquid or gas).Aim:To compare the value of pH monitoring and MII for diagnosis of GER in children who present with refractory respiratory symptoms.Materials:A prospective study that included 37 patients, aged 4.25 ± 3.15 years, using combined MII‐pH monitoring was performed. Patients were referred for investigation because of suspected GER as the etiology of recurrent respiratory diseases, including recurrent obstructive bronchitis, recurrent pneumonia, laryngitis, and chronic cough. We analyzed the percentage of time during which the pH was less than 4, the numeric and percentile values of acid, weak acid, and non‐acid reflux episodes, and the values of liquid and mixed reflux. Diagnostic values were determined separately for pH monitoring and MII using Fisher's exact test.Results:Reflux was detected in 31 patients. pH monitoring was positive in 20 patients (% time during which pH &lt;4 was 17.72 ± 12.06) and negative in 17 patients (2.93% ± 1.67). Both pH and MII were positive in 19 patients: in 11 patients, MII was positive and pH was negative, and in 6 patients, both were negative. Fisher's exact test showed significant statistical difference and superiority of MII in diagnosing GER (p = 0.033). Out of 30 patients with MII‐positive results, 15 had both acid and weak acid reflux episodes, 3 had only acid reflux, 8 had weak acid reflux, and 3 had non‐acid reflux. Sixteen patients had mixed (liquid and gas) reflux, and 14 had both liquid and mixed reflux.Conclusions:This study suggests that significant numbers of GER include weak acid reflux that cannot be detected by pH probes alone. The weak acid reflux could be a trigger for recurrent respiratory symptoms. Combining pH with MII monitoring is a valuable diagnostic method for diagnosing GER in children.