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Indications, Methodology, and Interpretation of Combined Esophageal Impedance-pH Monitoring in Children: ESPGHAN EURO-PIG Standard Protocol

Wenzl, Tobias G.*; Benninga, Marc A.; Loots, Clara M.; Salvatore, Silvia; Vandenplas, Yvan§on Behalf of the ESPGHAN EURO-PIG Working Group

Journal of Pediatric Gastroenterology and Nutrition: August 2012 - Volume 55 - Issue 2 - p 230–234
doi: 10.1097/MPG.0b013e3182592b65
Consensus Statement

Aim: The aim of the study was to provide an updated position statement from the ESPGHAN European Pediatric Impedance Working Group on different technical aspects such as indications, methodology, and interpretation of multichannel intraluminal impedance-pH monitoring (MII-pH).

Methods: Evidence was used where available, but the article is based mainly on expert opinion and consensus.

Results: MII-pH provides more information than simple pH monitoring because reflux detection is not limited to acid reflux. Different companies provide commercialized MII-pH recording systems, making the method widely available and useable in daily clinical practice; however, the technique still has limitations: high cost, limited additional value regarding therapeutic implications, and lack of evidence-based parameters for the assessment of gastroesophageal reflux and symptom association in children.

Conclusions: MII-pH recording is a promising procedure needing further validation and development to increase its additional benefit over conventional investigation techniques. The added value of the technique regards mainly clinical circumstances in which nonacid or weakly acid reflux may be relevant such as persisting symptoms during antireflux treatment with proton pump inhibitors and feeding-related reflux; and assessing specific discontinuous symptoms thought to be associated with gastroesophageal reflux; and research.

*Klinik für Kinder und Jugendmedizin, Universitätsklinikum der RWTH Aachen, Aachen, Germany

Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/AMC, Amsterdam, The Netherlands

U.O. Pediatria, Università dell’Insubria, Ospedale “F. Del Ponte,” Varese, Italy

§University Children's Hospital, Brussels, Belgium.

Address correspondence and reprint requests to Priv-Doz Dr med Tobias G. Wenzl, FRCPCH, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum der RWTH Aachen, Pauwelsstr 30, 52074 Aachen, Germany (e-mail:

Received 29 March, 2012

Accepted 30 March, 2012

T.G.W. is a consultant for Sandhill Scientific and Tecnomatix Germany. Y.V. is a consultant for United Pharmaceuticals and Biocodex. The other authors report no conflicts of interest.

© 2012 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,