Does Combined Multichannel Intraluminal Impedance and pH (MII-pH) Testing Improve Clinical Outcomes in Children With Gastroesophageal Reflux Disease?

Abstract

Objectives: The aim of the study was to investigate the role of combined multichannel intraluminal impedance and pH (MII-pH) testing in clinical management of children with gastroesophageal reflux disease (GERD) by exploring the impact of treatment changes made based on MII-pH testing results on symptoms and quality of life outcomes. Methods: All patients (<18 years) referred to the Sydney Children's Hospital for MII-pH testing were recruited. Patients were classified by acid suppression therapy (AST) status (on AST and off AST) and changes in medical and surgical management were evaluated. Validated questionnaires (Pediatric Gastroesophageal Symptom and Quality of Life Questionnaire and Infant Gastroesophageal Reflux Questionnaire Revised) were administered at baseline at the time of MII-pH testing, and 4 weeks after treatment changes were made and questionnaire scores were compared. Results: Of the 45 patients recruited, 24 patients (53.3%) were off AST and 21 patients (46.7%) were on AST. MII-pH testing led to medication changes in 30 patients (66.7%). This included 15 of 24 (62.5%) in those off AST and 15 of 21 (71.4%) in those on AST. More than 98% of patients who had treatment changes showed a significant improvement in both symptoms and quality of life scores. Conclusions: Our study is one of the first pediatric studies to evaluate the clinical validity of MII-pH testing in the pediatric population referred for suspected GERD, and its ability in guiding clinical management. Our study has shown that treatment decisions guided by and based on results of MII-pH testing led to a significant improvement in symptoms and quality of life in infants and children with GERD.

Combined multi-channel intraluminal impedance measurement and pHmetry in the detection of gastroesophageal reflux disease in children with cystic fibrosis

“…28 , 29 Most studies show higher specificity and sensitivity outcomes for MIIpH than for pHmetry alone. 7 , 10 , 16 , 17 In the present study, among the 10 patients with GERD, three patients were diagnosed by combined MII and pHmetry: 2/10 AGER+NAGER and 1/10 NAGER. The prevalence of 30% of patients with GERD confirmed by MIIpH and not pHmetry reiterates the importance of evaluating the esophageal content with MIIpH.…”

“…Previous research on MIIpH included children, adolescents, and adults, and, in some cases, it was performed in multiple centers. 10 , 11 , 12 , 13 , 14 , 17 , 18 …”

Enfermedad por reflujo gastroesofágico en pediatría. Diagnóstico y manejo basado en la evidencia

“…Sin embargo, es importante dejar patente que las diferentes revisiones sistemáticas y posicionamientos constatan que, con base en la literatura médica, actualmente no se puede recomendar ni tampoco oponerse al uso de los procinéticos en la ERGE, dada la falta de evidencia derivada de ensayos clínicos controlados de buena calidad; también establecen que podrían ser considerados, de acuerdo con el criterio del especialista, como terapia de última línea 1,52,53 . Existen ciertos estudios que muestran mejoría de la calidad de vida con el uso de procinéticos en aquellos con ERGE refractaria 39,40,54,55 .…”

Prokinetics in Childhood Gastroesophageal Reflux Disease

“…Prokinetics in our study were only started by specialist Pediatric Gastroenterologists after extensive investigation and when there was either a positive symptom association between symptoms and acid or nonacid reflux episodes and/or increased number of total reflux episodes. As such, this patient cohort represents a different population to the majority studied in prior systematic reviews (1)(2)(3)11).…”

“…T o the Editor: In the November issue of JPGN, Lee et al (1) evaluated the clinical validity of multichannel intraluminal impedance and pH (MII-pH) testing and its ability in guiding clinical management in 45 children and found that it led to medication changes in 30 (66.7%) patients. Change in treatment brought an improvement in gastrointestinal symptoms across all age groups.…”