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Does Reflux Monitoring With Multichannel Intraluminal Impedance Change Clinical Decision Making?

Rosen, Rachel; Hart, Kristen; Nurko, Samuel

Journal of Pediatric Gastroenterology and Nutrition: April 2011 - Volume 52 - Issue 4 - p 404–407
doi: 10.1097/MPG.0b013e3182078081
Original Articles: Gastroenterology

Objectives: Multichannel intraluminal impedance with pH (pH-MII) has become the criterion standard test for the evaluation of gastroesophageal reflux disease, but it is not clear whether the results of this test change clinical decision making. The goal of the present study was to determine the differences in clinical decision making by attending physicians based on the pH probe results versus MII results.

Methods: We conducted a prospective study in which physicians were initially given pH probe results and asked how they would change the patient's clinical management based on these results. Physicians were then given the MII results and asked how their management would change. Physicians then were asked whether they believed MII affected their clinical decision making overall.

Results: pH probe results changed clinical management 40% of the time and MII results changed clinical management an additional 22% of the time. Clinical decision making was not influenced by the performance of pH-MII on or off acid suppression. The escalation of acid suppression therapy was the main management change that occurred based on the pH-MII results.

Conclusions: The addition of MII to the standard pH probe resulted in a change in management in approximately 25% of the patients, suggesting that there may be a role for pH-MII in clinical practice.

Center for Motility and Functional Gastrointestinal Disorders, Children's Hospital Boston, Boston, MA, USA.

Received 26 July, 2010

Accepted 10 October, 2010

Address correspondence and reprint requests to Rachel Rosen, MD, MPH, Division of Gastroenterology and Nutrition, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115 (e-mail: rachel.rosen@childrens.harvard.edu).

This work was supported in part by NIDDK K23DK073713, the Children's Hospital Boston Career Development Award, and NIDDK K24DK082792.

The authors report no conflict of interest.

Copyright 2011 by ESPGHAN and NASPGHAN