A baseline impedance analysis in neurologically impaired children: A potent parameter for estimating the condition of the esophageal mucosa

Fukahori, Suguru; Yagi, Minoru; Ishii, Shinji; Asagiri, Kimio; Saikusa, Nobuyuki; Hashizume, Naoki; Yoshida, Misao; Masui, Daisuke; Komatsuzaki, Naoko; Higashidate, Naruki; Nakahara, Hiroyuki; Tanaka, Yoshiaki

doi:10.1111/nmo.13012

Cited by 8 publications

(7 citation statements)

References 32 publications

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“…Ideally, this examination should be performed by a well-trained and experienced analyst. Recently, in clinical research utilizing MII-pH measurement, interesting findings have been reported by Japanese pediatric surgeons [26][27][28]; for example, the utility of MII-pH for evaluation of the fundoplication effect [27] and the baseline impedance value known as potent parameters for estimating esophageal mucosal inflammation [28]. Improvements in the accuracy and standardization of analysis among examiners and institutions may be necessary to expand the application of MII-pH measurement in Japan.…”

Section: Discussionmentioning

confidence: 99%

Standard protocol devised by the Japanese Pediatric Impedance Working Group for combined multichannel intraluminal impedance-pH measurements in children

et al. 2019

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Multichannel intraluminal impedance-pH measurements (MII-pH) are useful for evaluating acid and non-acid gastroesophageal reflux (GER). However, the use of MIH-pH is not yet established in Japan. The Japanese Pediatric Impedance Working Group (Japanese-PIG) convened to devise a standard protocol for MII-pH in Japanese children. The expert members of the Japanese-PIG collected data on pediatric MII-pH from the relevant literature in English, including the standard protocol of MII-pH presented by the European PIG, and the insights of international experts. The resultant consensus was included in the contents of the standard protocol of MII-pH. The standard protocol included standardization of the indication, methodology, and interpretation of MII-pH in Japanese children. The criteria for abnormal GER by MII-pH were defined using the Reflux Index and number of total reflux episodes independently in children aged < 1 year and those aged ≥ 1 year. Moreover, a significant relationship between GER and symptoms was identified using the symptom index and symptom association probability approach. We conclude that the current version of the protocol for MII-pH is tentative because it is not based on data from Japanese children. Further studies are needed to render this protocol clinically beneficial and expand its use in Japan.

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Section: Discussionmentioning

confidence: 99%

Standard protocol devised by the Japanese Pediatric Impedance Working Group for combined multichannel intraluminal impedance-pH measurements in children

et al. 2019

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“…In contrast, Rossi et al reported the clinical appropriability of the MII-pH procedure in the diagnosis of GORD in children, confirmed by high rate of clinical response to the PPI therapy [ 21 ]. The data focusing on the characteristics of GORD based on MII-pH in children with NI are limited, furthermore the available studies differ with respect to the methodology and are based on small numbers of patients [ 10 , 22 , 23 , 24 ]. Del Buono et al, analysed the MII -pH tracings with respect to the mode of feeding—by mouth or naso-gastrically [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…No correlation with gastroscopy nor clinical exponents of GOR were included which limited the comparison of data provided by this study with our findings. Fukahori et al, (in a study primarily assessing the role of baseline impedance) retrospectively assessed pH-impedance tracings in 14 children with chronic NI (7 patients with erosive oesophagitis and 7 without endoscopic changes) and found no differences between the groups for any of the reflux types [ 10 ]. However, the authors did not provide the percentage of pathological tracings in the subgroups, and the group in which endoscopic results were available was limited in size.…”

Section: Discussionmentioning

confidence: 99%

“…The position statement on the indications, methods, and interpretation of pH-impedance in children, which adopted recommendations of EURO-PIG, was published by the British Society of Paediatric Gastroenterology, Hepatology and Nutrition in 2017 [ 7 ]. Although pH-impedance offers the possibility to precisely characterise and quantitatively assess GOR, the correlation between testing results and the endoscopic assessment of the oesophagus in children remains ambiguous and is based on several studies investigating clinically diverse groups of patients, with or without a neurological impairment (NI) [ 8 , 9 , 10 ]. It was shown that, in children with erosive oesophagitis, the number of specific reflux types recorded using the pH-impedance method was higher than in those with non-erosive reflux disease, while the qualitative interpretation of MII-pH did not differ between the compared groups of patients [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Oesophageal pH-Impedance for the Diagnosis of Gastro-Oesophageal Reflux Disease: Validation of General Population Reference Values in Children with Chronic Neurological Impairments

Plocek

Gębora-Kowalska

Fendler

et al. 2021

JCM

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Diagnosis of gastro-oesophageal reflux disease (GORD) in children with chronic neurological impairment (NI) remains a clinical challenge. The study aimed to validate the relevance of the reference values used to assess gastro-oesophageal reflux (GOR) in children with NI and to determine the optimal cut-off level of the pH-impedance parameter with the best predictive value for outcomes associated with endoscopic assessments of the oesophagus. Sixty-seven children (32 male, 35 female; age: interquartile range, 5 years 6 months–14 years 10 months; median, 11 years 3 months) with NI were prospectively recruited for the study. The exclusion criteria were previous fundoplication and lack of consent for the study. All patients underwent evaluations for GOR disease, including pH-impedance and gastroscopy. Based on endoscopy, oesophagitis was diagnosed in 22/67 children (32.8%); 9/67 (13.4%) were classified as having Hetzel–Dent grade III or IV. GOR was present in 18/67 children (26.9%), as determined by pH-impedance. Patients with endoscopic lesions had a significantly higher number of total reflux (p = 0.0404) and acidic episodes (p = 0.0219). The total number of reflux episodes, with a cut-off level of 44 episodes, was the pH-impedance parameter most strongly predictive of the presence of lesions in gastroscopy (specificity: 50%, sensitivity: 73%). These findings suggest that endoscopic lesions may be present in children with chronic NI with a low number of GOR episodes, as recorded by pH-impedance. The use of standardised reference norms determined for the general population may underestimate GOR episodes in this group of patients.

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“…The 102 published clinical studies about children with SNI fall into seven clinical topics. Gastroesophageal reflux and feeding tubes (n = 57, 56%) was the most common topic, with subtopics of gastroesophageal reflux (n = 7), 7,[42][43][44][102][103][104] gastrostomy tube outcomes (n = 24), 9,39,45,46,[56][57][58][59][60][61][62][63][64][65][81][82][83][84][105][106][107][108][109][110] and antireflux procedures (n = 26). 8,[47][48][49][50][51][52][53][54][55][66][67][68][69][70][71]85,86,…”

Section: Primary Topics Of Studiesmentioning

confidence: 99%

Clinical characteristics of children with severe neurologic impairment: A scoping review

Nelson

Finlay

Huang

et al. 2022

Journal of Hospital Medicine

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Objective: The aim of this study is to extrapolate the clinical features of children with severe neurologic impairment (SNI) based on the functional characteristics and comorbidities described in published studies.Methods: Four databases were searched. We included studies that describe clinical features of a group of children with SNI (≥20 subjects <19 years of age with >1 neurologic diagnosis and severe functional limitation) using data from caregivers, medical charts, or prospective collection. Studies that were not written in English were excluded. We extracted data about functional characteristics, comorbidities, and study topics. Results:We included 102 studies, spanning 5 continents over 43 years, using 41 distinct terms for SNI. The terms SNI and neurologic impairment (NI) were used in 59 studies (58%). Most studies (n = 81, 79%) described ≥3 types of functional

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A baseline impedance analysis in neurologically impaired children: A potent parameter for estimating the condition of the esophageal mucosa

Cited by 8 publications

References 32 publications

Standard protocol devised by the Japanese Pediatric Impedance Working Group for combined multichannel intraluminal impedance-pH measurements in children

Standard protocol devised by the Japanese Pediatric Impedance Working Group for combined multichannel intraluminal impedance-pH measurements in children

Oesophageal pH-Impedance for the Diagnosis of Gastro-Oesophageal Reflux Disease: Validation of General Population Reference Values in Children with Chronic Neurological Impairments

Clinical characteristics of children with severe neurologic impairment: A scoping review

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