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 eVect 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 buVering of gastric acidity rather than the absence of reflux. (Arch Dis Child 2001;84:273-276)

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Results Eight-four (63%) of the 133 were categorised, using the RFH-GA, as being moderately or severely malnourished. In contrast the MUST tool identified only 45 (34%) patients as being at nutritional risk. Thus the sensitivity and specificity of MUST for determining nutritional risk were 34% (95% CI 20 to 51) and 94% (95% CI 86 to 97); respectively; the k value was 0.19 demonstrating a poor level of agreement. The sensitivity and specificity of MUST improved when the patients with fluid retention were excluded from the analysis, 100% (95% CI 46 to 100) and 91% (74e98); respectively. The performance of the MUST also improved as the accurate dry body weight was better calculated but still did not reach 100% sensitivity indicating body weight alone is not a good marker of nutritional status in this patient population.The performance of the MUST utilising alternative weight adjustments in patients with fluid retention Conclusion The performance characteristics of the MUST tool in this setting are poor. This tool, can not be recommended for screening patients with chronic liver disease for nutritional risk.