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Esophageal Impedance and Esophagitis in Children: Any Correlation?

Salvatore, S*; Hauser, B; Devreker, T; Arrigo, S*; Marino, P*; Citro, C*; Salvatoni, A*; Vandenplas, Y

Journal of Pediatric Gastroenterology & Nutrition: November 2009 - Volume 49 - Issue 5 - p 566–570
doi: 10.1097/MPG.0b013e3181a23dac
Original Articles: Gastroenterology

Aim: The aim of this study was to correlate the data obtained with multiple intraluminal esophageal impedance and pH (MII-pH) recordings in infants and children referred for suspected gastroesophageal reflux disease with esophageal histology.

Materials and Methods: In a prospective study, results of esophageal biopsies and MII-pH recording obtained in 45 children (mean age ± SD: 69 ± 55 months) were analyzed. Regarding the MII-pH data, an automatic (Autoscan Bioview Analysis Software, version 5.3.4, Sandhill Scientific Inc, Highlands Ranch, CO) and a manual reading were performed; an automatic pH analysis (meal included) was also performed.

Results: Acidic, weakly acidic, and alkaline reflux episodes accounted, respectively, for 48.7%, 49.5%, and 1.8% of the total number of reflux episodes detected by MII-pH. Esophagitis was present in 25 (56%) children. Concordance between classic pH-study analysis (alone) and esophageal histology was found in 19 of 45 (42%) children. According to the MII-pH analysis, the mean and median value of the pH were significantly higher in the group with esophagitis than in the group with normal esophageal histology. A longer clearance time was found in the group with esophagitis than in subjects with normal histology. Gas reflux episodes represented 21% of the total reflux episodes and were comparable in both groups.

Conclusions: Multiple intraluminal esophageal impedance and pH analysis does not provide a distinct parameter to predict esophageal mucosal injury in children. In our population, MII-pH shows comparable acidic, weakly acidic, alkaline, and gas reflux in children with and without esophagitis. Further research is needed to analyze clearance parameters.

*Clinica Pediatrica, Università dell'Insubria, Varese, Italy

Universitair Ziekenhuis Brussel Kinderen, Brussels, Belgium

Received 7 June, 2008

Accepted 16 February, 2009

Address correspondence and reprint requests to Y. Vandenplas, UZ Brussel Kinderen, Laarbeeklaan 101, 1090 Brussels, Belgium (e-mail:

The authors report no conflicts of interest.

© 2009 Lippincott Williams & Wilkins, Inc.