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Intraesophageal Pressure Recording Improves the Detection of Cough During Multichannel Intraluminal Impedance Testing in Children

Rosen, Rachel; Amirault, Janine; Giligan, Emily; Khatwa, Umakanth; Nurko, Samuel

Journal of Pediatric Gastroenterology and Nutrition: January 2014 - Volume 58 - Issue 1 - p 22–26
doi: 10.1097/MPG.0b013e3182a80059
Original Articles: Gastroenterology

Background: One of the primary reasons for referral for reflux testing is to correlate reflux events with symptoms such as cough. Adult studies have suggested that symptom recording is flawed and pediatricians feel this is an even more significant problem because there may be errors in both parental and patient reports. We hypothesize that intraesophageal pressure recording (IEPR) provides an objective method to identify coughs during reflux testing in children.

Methods: We recruited 20 children undergoing multichannel intraluminal impedance with pH (pH-MII) testing for the evaluation of cough. We placed simultaneous intraesophageal pressure and pH-MII catheters. Tracings were blindly scored by 2 observers without knowledge of patient/parent symptom report. After the blinded scoring, patient/parent report of symptoms was recorded.

Results: Ninety-four percent of all coughs were detected by IEPR and only 48% of all coughs were reported by patients/parents. The mean time from the IEPR cough to the patient/parent cough was 11 ± 16 seconds. Using IEPR as the criterion standard for the detection of cough, the sensitivity of patient report for the detection of cough is 46%. Using varying symptom windows because of the increased precision of IEPR, the number of patients with a positive symptom index could be reduced from 30% to 0%, preventing children from being falsely categorized as having reflux-related lung disease.

Conclusions: Parental and patient symptom recording in children is inadequate for making the diagnosis of reflux-related lung disease. If patients undergo pH-MII testing for reflux-related cough, IEPR should become the new standard by which to correlate reflux with cough.

Aerodigestive Center, Boston Children's Hospital, Boston, MA.

Address correspondence and reprint requests to Rachel Rosen, MD, MPH, 300 Longwood Ave, Boston, MA 02115 (e-mail:

Received 3 August, 2013

Accepted 3 August, 2013

This work was financially supported through NIH K23 DK073713-05 (R.R.) 1R03DK089146-02 (R.R.), K24DK082792A (S.N.) and Translational Research Program Junior Investigator Award (R.R.).

The authors report no conflicts of Interest.

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,