Pediatrics and neonatology · 2025
Multichannel intraluminal impedance-pH monitoring for evaluation of gastroesophageal reflux mimics in infants with comorbidities.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Chang En-Shuo, Chen Mi-Chi, Chiu Chih-Yung, Yeh Pai-Jui, Lai Ming-Wei, Chen Chien-Chang, Chao Hsun-Chin
Аннотация
BACKGROUND: Infants with comorbidities and critical illnesses often exhibit symptoms resembling extra-esophageal reflux episodes, posing a challenge to differentiate from exacerbated underlying conditions. This study aimed to evaluate characteristics of equivocal gastroesophageal reflux (GER)-like symptoms using 24-h esophageal multichannel intraluminal impedance-pH (MII-pH) monitoring in infants with comorbidities.
METHODS: This retrospective study enrolled 79 infants, who were all less than 1 year of age and received 24-h MII-pH monitoring. Abnormal result was defined as reflux index >10 %, total reflux episodes >100 times, and more than 44 acidic GER episodes or 57 non-acid ones.
RESULTS: Among the infants, 64.6 % required intensive care, 41.8 % were under positive pressure ventilation and 73.4 % were fed with feeding tube. Approximately 70 percent of babies presented with extra-esophageal symptoms. Common comorbidities were as follows: prematurity (65.8 %), laryngomalacia (46.5 %), neurological impairment (40.5 %), and bronchopulmonary dysplasia (38.0 %). Abnormal results of MII-pH monitoring were observed in 39.2 % subjects, which were significantly higher in infants with esophageal symptoms, and characterized by higher total reflux as well as acidic reflux episodes. There were markedly lower weakly acidic reflux episodes in infants with neurological impairment and higher proximal reflux episodes in infants with laryngomalacia.
CONCLUSION: Despite higher prevalence of extra-esophageal presentations among all infants with comorbidities, abnormal rates of 24-h esophageal MII-pH monitoring were significantly lower compared with those of infants with esophageal presentations. Routine use of proton-pump inhibitor is not warranted for non-esophageal symptoms in high-risk infants with undocumented gastroesophageal reflux disease.
METHODS: This retrospective study enrolled 79 infants, who were all less than 1 year of age and received 24-h MII-pH monitoring. Abnormal result was defined as reflux index >10 %, total reflux episodes >100 times, and more than 44 acidic GER episodes or 57 non-acid ones.
RESULTS: Among the infants, 64.6 % required intensive care, 41.8 % were under positive pressure ventilation and 73.4 % were fed with feeding tube. Approximately 70 percent of babies presented with extra-esophageal symptoms. Common comorbidities were as follows: prematurity (65.8 %), laryngomalacia (46.5 %), neurological impairment (40.5 %), and bronchopulmonary dysplasia (38.0 %). Abnormal results of MII-pH monitoring were observed in 39.2 % subjects, which were significantly higher in infants with esophageal symptoms, and characterized by higher total reflux as well as acidic reflux episodes. There were markedly lower weakly acidic reflux episodes in infants with neurological impairment and higher proximal reflux episodes in infants with laryngomalacia.
CONCLUSION: Despite higher prevalence of extra-esophageal presentations among all infants with comorbidities, abnormal rates of 24-h esophageal MII-pH monitoring were significantly lower compared with those of infants with esophageal presentations. Routine use of proton-pump inhibitor is not warranted for non-esophageal symptoms in high-risk infants with undocumented gastroesophageal reflux disease.