PRINCIPLES OF COMBINED ESOPHAGEAL IMPEDANCE-PH MONITORING IN CHILDREN: INDICATIONS, BENEFITS AND LIMITATIONS

Abstract

The standard test for suspected gastroesophageal refl ux is pH monitoring. However, the majority of gastroesophageal refl ux episodes in infants and children are nonacidic (pH > 4) and extraesophageal symptoms apparently can be caused by both acidic (pH < 4) and nonacidic reflux. In order to overcome these aspects, a new technique has been developed and placed under scrutiny in the past twenty years: multichannel intraluminal impedance. Combined with standard pH recording, it provides more information than simple pH measurement because it allows the study of non-acid refl ux and the temporal association between symptoms and nonacid refl ux. Data can be analyzed for bolus composition (gas, fl uid, solid) and refl ux height, duration, and clearance. Although normal values for the pediatric population are not yet available, combined multichannel intraluminal impedance and pH measurement has the potential to become the new “gold standard” for gastroesophageal refl ux testing.

Keywords

• children
• adolescents
• gastroesophageal refl ux
• esophageal impedance
• esophageal ph monitoring
• combined esophageal impedance-ph monitoring
• esophagus
• diagnosis
• medical