Comparison of multichannel intraluminal impedance-pH monitoring and reflux scintigraphy in pediatric patients with suspected gastroesophageal reflux

Abstract

AIMTo evaluate the agreement of multichannel intraluminal impedance-pH monitoring (MII-pHM) and gastroesophageal reflux scintigraphy (GES) for the diagnosis of gastroesophageal reflux disease.METHODSSeventy-five consecutive patients with suspected gastroesophageal reflux disease (GERD) underwent 24-h combined MII-pHM recording and one hour radionuclide scintigraphy during the course of the MII-pHM study. Catheters with 6 impedance channels and 1 pH sensor were placed transnasally. Impedance and pH data analysis were performed automatically and manually. For impedance monitoring, reflux was defined as a retrograde 50% drop in impedance, starting distally and propagating retrogradely to at least the next two more proximal measuring channels. Reflux index (RI, percentage of the entire record that esophageal pH is < 4.0) greater than 4.2% for pHM and number of refluxes more than 50 for 24 h for MII were accepted as positive test results. At scintigraphy, 240 frames of 15 seconds duration were acquired in the supine position. Gastroesophageal reflux was defined as at least one reflux episode in the esophagus. After scintigraphic evaluation, impedance-pH recordings and scintigraphic images were evaluated together and agreement between tests were evaluated with Cohen’s kappa.RESULTSSufficient data was obtained from 60 (80%) patients (34 male, 56.7%) with a mean age of 8.7 ± 3.7 years (range: 2.5-17.3 years; median: 8.5 years). Chronic cough, nausea, regurgitation and vomiting were the most frequent symptoms. The mean time for recording of MII-pHM was 22.8 ± 2.4 h (range: 16-30 h; median: 22.7 h). At least one test was positive in 57 (95%) patients. According to diagnostic criteria, GERD was diagnosed in 34 (57.7%), 44 (73.3%), 47 (78.3%) and 51 (85%) patients by means of pHM, MII, GES and MII-pHM, respectively. The observed percentage agreements/κ values for GES and pHM, GES and MII, GES and MII-pHM, and MII and pHM are 48.3%/-0.118; 61.7%/-0.042; 73.3%/0.116 and 60%/0.147, respectively. There was no or slight agreement between GES and pHM alone, MII alone or MII-pHM. pH monitoring alone missed 17 patients compared to combined MII-pHM. The addition of MII to pH monitoring increased the diagnosis rate by 50%.CONCLUSIONNo or slight agreement was found among pH monitoring, MII monitoring, MII-pH monitoring and GES for the diagnosis of gastroesophageal reflux disease.

Infantlarda ve Çocuklarda Gastroözefagial Reflü Hastalığının Gastoözefagial Reflü Sintigrafisi ile Değerlendirilmesi

“…The sensitivity of GERS for GERD has been reported to be between 75 % (19) to 100 % (20,21) whereas the specificity of GERS is around 100 % (19) but depends on the protocol used (22,23) and also the experience of the expert (20,21). However, because of the relatively low sensitivity reported in later reports (2), GERS may be indicated when GERD symptoms are not responding to standard therapies and other diagnoses or triggers such as delays in gastric emptying (2,24).…”

“…The diagnosis of GERD can rely on various tests such as 24-h esophageal pH monitoring (pHM), multichannel esophageal intraluminal impedance testing (MII), combined MII and pHM (MII-pHM), gastroesophageal reflux scintigraphy (GERS), upper gastrointestinal barium contrast radiography, esophagoscopy and biopsy, motility studies and ultrasonography. However, particularly for the pediatric population, these tests have advantages and limitations, and none of them can be considered as an ideal test (1,2). The main challenge in the diagnosis is to differentiate the physiological GER events from GERD.…”

A One Health review of aerodigestive disease in dogs

“…Small volume reflux and microaspiration events might require adjunctive measures including reflux scintigraphy 10 . Ambulatory pH monitoring, though useful, might fail to detect nonacidic reflux events or those in dogs currently receiving proton pump inhibitors 130,250 . Treatment trials for GERD and EERD remain a mainstay in clinical practice.…”

Gastroesophageal Reflux Events Occurring During a Meal Can Still Be Temporally Associated With a Symptom Even When Analysis Settings Are Set to Exclude Meals

“…TO THE EDITOR: Combined multichannel intraluminal impedance and pH monitoring (MII-pH) is becoming the gold standard for assessing gastroesophageal reflux (GER) and for assessing the temporal relationship between GER and symptoms. [1][2][3] Using MII-pH reflux measuring systems (like Medical Measurements Systems [MMS]; Amsterdam, The Netherlands), 24-hour MII-pH studies are manually scanned for the presence of GER episodes and for various symptoms that have been recorded over the course of the study. Traditionally, "mealtimes" are excluded from the analysis 4 so that esophageal acidification that may occur during feeding will not be considered when calculating total esophageal acidification (ie, reflux index) and because rapid swallows can occasionally be misinterpreted as reflux events.…”