Simultaneous Monitoring of Gastric and Oesophageal PH Reveals Limitations of Conventional Oesophageal PH Monitoring in Milk Fed Infants

Overview

Journal Arch Dis Child

Specialty Pediatrics

Date 2001 Feb 24

PMID 11207184

Citations 33

Authors

D J Mitchell

B G McClure

T R Tubman

Affiliations

Soon will be listed here.

Abstract

Background: Monitoring oesophageal pH conventionally detects "acid reflux" (pH less than 4). The pH of the gastric contents determines whether or not reflux can be detected.

Aim: To monitor gastric and oesophageal pH simultaneously in order to determine the effect of milk feeds on gastric pH and how this would influence interpretation of the oesophageal pH record.

Methods: Milk fed infants for whom oesophageal pH monitoring was requested underwent simultaneous gastric and oesophageal pH monitoring using a dual channel pH probe.

Results: Twenty of 24 records were technically satisfactory. Mean reflux index was 1.0%, range 0.0-4.0%. Gastric pH was less than 4 for 24.5% (range 0.6-69.1%) of the total time. The average time the gastric pH was greater than 4 after feeds was 130 minutes (range 29-212 minutes). The corrected reflux index (limited to the time the gastric pH was less than 4) was 2.6% (range 0.0-11.0%).

Conclusion: The pH of the gastric contents may be greater than 4 for prolonged intervals, during which oesophageal pH monitoring using current criteria cannot detect reflux nor correlate it with clinical events. A low reflux index may reflect prolonged buffering of gastric acidity rather than the absence of reflux.

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References

Novak D . Gastroesophageal reflux in the preterm infant. Clin Perinatol. 1996; 23(2):305-20. View

Davies A, Sandhu B . Diagnosis and treatment of gastro-oesophageal reflux. Arch Dis Child. 1995; 73(1):82-6. PMC: 1511163. DOI: 10.1136/adc.73.1.82. View

Wenzl T, Silny J, Schenke S, Peschgens T, Heimann G, Skopnik H . Gastroesophageal reflux and respiratory phenomena in infants: status of the intraluminal impedance technique. J Pediatr Gastroenterol Nutr. 1999; 28(4):423-8. DOI: 10.1097/00005176-199904000-00014. View

Washington N, Spensley P, Smith C, Parker M, Bush D, Jackson S . Dual pH probe monitoring versus single pH probe monitoring in infants on milk feeds: the impact on diagnosis. Arch Dis Child. 1999; 81(4):309-12. PMC: 1718105. DOI: 10.1136/adc.81.4.309. View

Jolley S, Herbst J, Johnson D, Matlak M, Book L, Pena A . Postcibal gastroesophageal reflux in children. J Pediatr Surg. 1981; 16(4):487-90. DOI: 10.1016/s0022-3468(81)80012-7. View

Lucas A, Bloom S, Aynsley-Green A . Postnatal surges in plasma gut hormones in term and preterm infants. Biol Neonate. 1982; 41(1-2):63-7. DOI: 10.1159/000241518. View

Harada T, Hyman P, Everett S, Ament M . Meal-stimulated gastric acid secretion in infants. J Pediatr. 1984; 104(4):534-8. DOI: 10.1016/s0022-3476(84)80542-9. View

Sondheimer J, Clark D, Gervaise E . Continuous gastric pH measurement in young and older healthy preterm infants receiving formula and clear liquid feedings. J Pediatr Gastroenterol Nutr. 1985; 4(3):352-5. DOI: 10.1097/00005176-198506000-00005. View

Vandenplas Y . Continuous 24-hour esophageal pH monitoring in 285 asymptomatic infants 0-15 months old. J Pediatr Gastroenterol Nutr. 1987; 6(2):220-4. DOI: 10.1097/00005176-198703000-00010. View

10.

Vandenplas Y, Sacre L, LOEB H . Effects of formula feeding on gastric acidity time and oesophageal pH monitoring data. Eur J Pediatr. 1988; 148(2):152-4. DOI: 10.1007/BF00445926. View

11.

Ng S, Quak S . Gastroesophageal reflux in preterm infants: norms for extended distal esophageal pH monitoring. J Pediatr Gastroenterol Nutr. 1998; 27(4):411-4. DOI: 10.1097/00005176-199810000-00009. View

12.

Newell S, Booth I, Morgan M, Durbin G, McNeish A . Gastro-oesophageal reflux in preterm infants. Arch Dis Child. 1989; 64(6):780-6. PMC: 1792568. DOI: 10.1136/adc.64.6.780. View

13.

Jolley S, Halpern C, Sterling C, FELDMAN B . The relationship of respiratory complications from gastroesophageal reflux to prematurity in infants. J Pediatr Surg. 1990; 25(7):755-7. DOI: 10.1016/s0022-3468(05)80012-0. View

14.

Tappin D, King C, Paton J . Lower oesophageal pH monitoring--a useful clinical tool. Arch Dis Child. 1992; 67(1):146-8. PMC: 1793559. DOI: 10.1136/adc.67.1.146. View

15.

Vandenplas Y, Derde M, Piepsz A . Evaluation of reflux episodes during simultaneous esophageal pH monitoring and gastroesophageal reflux scintigraphy in children. J Pediatr Gastroenterol Nutr. 1992; 14(3):256-60. DOI: 10.1097/00005176-199204000-00003. View

16.

JAMIESON J, Stein H, DeMeester T, Bonavina L, Schwizer W, Hinder R . Ambulatory 24-h esophageal pH monitoring: normal values, optimal thresholds, specificity, sensitivity, and reproducibility. Am J Gastroenterol. 1992; 87(9):1102-11. View

17.

Booth I . Silent gastro-oesophageal reflux: how much do we miss?. Arch Dis Child. 1992; 67(11):1325-7. PMC: 1793773. DOI: 10.1136/adc.67.11.1325. View