Gastro-oesophageal reflux disease (GORD) is fairly common in the paediatric population with approximately 10–15% of children affected by it, with predominance in infancy1. Gastro-oesophageal reflux (GOR) can be objectively assessed by ph and/or combined multichannel intraluminal impedance (MII) monitoring which allows detection of most gastroesophageal reflux episodes, acid as well as non-acid reflux.

Objectives 1. The aim of this evaluation was to measure the current practice and to provide recommendations for improvement.

2. Determine the diagnostic yield of this technique in children with suspected reflux symptoms.

Patients and Methods The recordings of 245 children from 2007 to 2022 were collected, including whether endoscopy was performed and if a chest x-ray was done to detect the placement of the catheter. Reflux index of more than 4.2% was used as the cut-off for a presence of GOR in a patient. For combined MII studies, a cut off 70 episodes in less than 1 year age and 100 episodes in more than 1 year age was taken as a positive finding. The temporal relationship between symptoms and reflux episodes was analysed with symptom index (SI) >50% and a symptom association probability (SAP) > 95% considered indicative of a positive association.

Results A total of 245 studies from 2014 to 2022 were evaluated. A total of 198 pH studies and 47 MII were recorded. There were 157 boys and 88 girls with an age range of 0.1–18.0 years. More studies were done in 2015 and 2019, 44 each and the least was performed in 2007. The average duration of a study was 22 hours. Majority of studies (81), about 33% were performed in the 6 to 12 years category and about 17% (42 patients) were done in children less than 1 year of age. In 149 (60.8%) children an endoscopy was also performed. In the 245 studies, only 89 (36.3%) had x-rays to confirm the position of catheters. A significant presence of GOR, using Reflux index >4.2%, was found in 67 of the 245 studies (27.3%) evaluated. 24 patients (57%) in the less than 1 year age group had more than 70 episodes documented while there were 21 patients (10%) in the more than 1 year age group who had more than 100 episodes. A positive SAP was found in 48 (19.6%) patients including acid reflux in 42 (17%) and non-acid reflux in 6 (2.4%). A positive SI (>50%) was found in 50 (20.4%) patients, including acid reflux in 46 (18.8%) and non-acid reflux in 4 (1.63%).

Conclusion Our analysis found a significantly higher incidence (27%) of GOR in the children that we studied and perhaps this was a selected group being seen in a specialist paediatric gastroenterology clinic. There was also a significant proportion (57%) of children in the less than 1 year age group to be having increased number of reflux episodes and the perhaps we are capturing a normal physiological process. We also recommend that confirming tip position during endoscopy is a relatively safe alternative to performing a chest x-ray to confirm catheter placement. Combined pH-MII studies are recommended for a better diagnostic yield and symptom correlation, especially in the younger age group.

Reference

1. El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2014 Jun;63(6):871–80. doi: 10.1136/gutjnl-2012-304269. Epub 2013 Jul 13. PMID: 23853213; PMCID: PMC4046948.