231 24Hr Ph-Study and Multiple Intraluminal Impedance (MII) for the Diagnosis of Gastroesophageal Reflux and Evaluation of Related Symptoms in Children (Italy)

Abstract

Background and aim: PH-monitoring is the most widely accepted tool for the diagnosing of gastroesophageal reflux (GER); however it does not detect non acid refluxes. MII is a new method for pH-indipendent detection of GER however, few data are available in childhood. Our aim was to compare the 24hr pH-study versus the combined 24-hrs pH and MII monitoring for the assessment of GER and related symptoms in children.Methods: Fourteen children [M 7; mean age: 1,2 y (range 0,42 y -10,4 y)] with symptoms suggestive of GER, underwent 24hr pH-study/MII recording. Reflux episodes revealed by 24hr pH-study were analysed at the light of the retrograde bolus movements detected by MII. The symptom index (SI) and the symptom sensitivity index (SSI) were calculated for both the techniques and according with the type of symptoms (typical or atypical).Results: In the 14 children studied, the MII detected 1145 episodes of reflux of which 660 (58%) were associated with decreases in pH less than 4.0. The analysis of the 24hr pH-study blinded to the impedance data revealed a total of 1232 reflux episodes; of these only 660 were also associated with retrograde bolus movement detected by MII (SS and PPV of 24hr pH-study compared to MII: 54% and 58%). A total of 109 symptoms were reported: 58 typical and 51 atypical. The SI and SSI were significantly higher for the MII as compared to 24hr pH-study [(total symptoms: 58% and 5,5% vs. 28% and 2,5%; pϽ0,00002 and pϽ0,0004 respectively), (typical symptoms: 62% and 3,1% vs. 40% and 1,8%; pϽ0,01 and pϽ0,05 respectively) and (atypical symptoms: 53% and 2,4% vs. 18% and 0,7%; pϽ0,0004 and pϽ0,002 respectively).Summary and conclusions: More than 40% of reflux episodes detected by pH-monitoring are not associated with retrograde bolus movement (false positive) and are responsible for the low PPV of the 24hr pH-study. SI and SII are significantly higher if assessed by MII especially for atypical symptoms, demonstrating the superiority of MII for the study of atypical manifestation of GER. Aim: To evaluate the predictive value of relevant clinical and laboratory parameters [complete blood count, serum C-reactive protein (CRP), procalcitonin (PCT) and Staphylococcus-specific PCR] in neonates suspected of having developed LOS. REVISED APPROACH TO SUSPECTED LATE-ONSET SEPSIS IN NEO-NATES: ADDED VALUE OF C-REACTIVE PROTEIN AND STAPHYLOCOC-CUS-SPECIFIC PCR.Patients and Methods: NICU neonates were prospectively followed for suspected septic events. During the study period, 111 neonates developed 148 suspected septic events beyond 3 days of age, and comprised the study population. Clinical signs and laboratory abnormalities at onset of sepsis were recorded, including serum levels of CRP and PCT, results of Staphylococcus-specific PCR, microbiological data and the AMT instituted.Results: Of the 148 events of suspected LOS, 26 (17.6%) had positive blood cultures (proven LOS) with gram-positive bacteria, gram-negative bacteria and Candida, accounting for 65.4%, 23.1% and 11.5% of the events, respectively. Va...