“pH‐Only” Acid Reflux Events in Infants During Later Phases of the Feeding Cycle Are Less Acidic and Cleared More Efficiently Than Classic 2‐Phase Acid Reflux Events

Woodley, Frederick W.; Mousa, Hayat

doi:10.1097/mpg.0b013e31816f214a

Cited by 12 publications

(15 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previously, Jadcherla et al (19) correlated the spatio-temporal relationship of ascending events to elicited symptoms and Woodley et al . compared the specific reflux characteristics (frequency, ACT, and BCT) between impedance positive and pH-only events (36). However, the current study is unique in that we have characterized an approach to define true GERD symptoms that merit appropriate management and follow up.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of Esophageal Acidification on Troublesome Symptoms: An Approach to Characterize True Acid GERD in Dysphagic Neonates

et al. 2017

View full text Add to dashboard Cite

Objective To quantify and compare maximal extent (height) of acid reflux events (AREs) on symptom generation in dysphagic neonates. Methods Dysphagic neonates (N=53), born at 30 ± 5.3 wks gestation, underwent 24-hour pH-impedance study for the evaluation of troublesome symptoms purported to be due to gastroesophageal reflux disease (GERD). AREs (pH < 4 for > 4 seconds) detected by impedance (Z) were categorized by maximal extent as refluxate reaching distal (Z6, Z5), middle (Z4, Z3), or proximal (Z2, Z1) impedance channels. AREs reaching the pH sensor only were categorized as distal. Symptom correlation (%, symptom index (SI), symptom sensitivity index (SSI), and symptom associated probability (SAP)) and temporal characteristics (clearance times) of AREs were analyzed using linear mixed and GEE models comparing height categories presented as mean ± SEM, median (IQR), and OR (95% CI). Results Of the 2003 AREs: 1) distal extent AREs (n=1642) had increased frequency (p < 0.05), decreased ACT (p<0.05), and decreased acidity (p<0.05), 2) in middle and proximal AREs, acid clearance was longer than bolus clearance, p < 0.01, and 3) the odds of having cardiorespiratory (cough or sneeze) symptoms are increased with proximal and middle AREs (p<0.05). Conclusion Most proximal ascent of AREs into middle or proximal esophagus likely activates protective aerodigestive reflexes (peristalsis) or vigilant states to facilitate bolus and chemical clearance. Heightened esophageal sensitivity, acid neutralization delays, or clearance mechanism delays may accentuate multi-systemic troublesome symptoms.

show abstract

Section: Discussionmentioning

confidence: 99%

“…ARE maximal extent, or height, was arbitrarily defined as distal (Z6, Z5), middle (Z4, Z3), or proximal (Z2, Z1) extent detected by the pH-impedance probe (Figure 1) (9, 19, 35, 36). To be detected by impedance sensors, an ARE must drop ≥ 50% from baseline originating in the Z6 channel.…”

Section: Methodsmentioning

confidence: 99%

Effects of Esophageal Acidification on Troublesome Symptoms: An Approach to Characterize True Acid GERD in Dysphagic Neonates

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Studies conducted in symptomatic term infants found that impedance monitoring misses 9% to 40% of acid reflux episodes [31,32]. There are several possible reasons for these missed episodes such as insignificant bolus size, reflux esophagitis, slow pH drift caused by esophageal shortening, the residuals of acid MII reflux that were not completely cleared and short-column acid reflux episodes that do not meet the scoring rules by definition [21,33,34,35,36]. …”

Section: Ph-only Acid Relfux Episodesmentioning

confidence: 99%

Esophageal pH and Combined Impedance-pH Monitoring in Children

Shin

2014

Pediatr Gastroenterol Hepatol Nutr

View full text Add to dashboard Cite

Esophageal pH monitoring is considered the gold standard for the diagnosis of gastroesophageal reflux disease because of the normal ranges across the pediatric age range. However, this method can only detect acid reflux. Multichannel intraluminal impedance-pH (MII-pH) monitoring has recently been used for the detection of bolus reflux in infants and children. This method allows for the detection of liquid, gas or mixed reflux in addition to acid, weakly acidic or weakly alkaline reflux. MII-pH monitoring can record the direction of flow and the height of reflux, which are useful parameters to identify an association between symptoms and reflux. However, the technique is limited by its high cost and the lack of normative data of MII-pH in the pediatric population. Despite certain limitations, MII-pH monitoring will become more common and gradually replace pH monitoring in the future, because pH monitoring is part of MII-pH.

show abstract

“…In standard pH‐metry, only well‐defined drops in pH are classified as reflux episodes. In nearly all MII–pH recordings, pH drops without retrograde bolus movements can be found 6,7 . However, some patients present with significant differences in the number of GER episodes detected with pH‐metry and MII.…”

Section: Introductionmentioning

confidence: 99%

“…In nearly all MII-pH recordings, pH drops without retrograde bolus movements can be found. 6,7 However, some patients present with significant differences in the number of GER episodes detected with pH-metry and MII. Until now, it is uncertain if the so-called pH-only reflux episodes that consist of a pH drop without evidence of retrograde bolus movement in MII truly represent reflux episodes or if they are of artificial nature.…”

Section: Introductionmentioning

confidence: 99%

Small volume acid reflux in gastroesophageal reflux disease patients with hiatal hernia is only detectable by pH-metry but not by multichannel intraluminal impedance

Weigt

Malfertheiner

2012

Diseases of the Esophagus

View full text Add to dashboard Cite

Until now, it is uncertain if the so-called pH-only reflux episodes that consist of a pH drop without evidence of retrograde bolus movement in multichannel intraluminal impedance (MII) represent reflux episodes or artifacts. Hiatal hernia (HH) may allow reflux of small volumes to occur that can be detected by pH-metry but not by MII. The aim was to search for a mechanism that can explain pH-only reflux, 20 patients (12 females and 8 males, median age 52 years, interquartile range [IQR]: 40.5-60.75 years) were investigated with MII-pH off PPI. Impedance and pH-metry data were analyzed separately. The differences in detection rate of acid reflux between pH-metry and MII were correlated with the presence of HH. In an in vitro experiment, MII-pH probes were flushed with citric acid in plastic tubes of different size with capillary diameter and diameters of 2.5 mm and 4.5 mm, while recording pH values and impedance. HH was present in six patients and absent in 14 patients. In patients with HH in comparison with patients with absent HH, the difference of acid reflux detection between pH-metry and MII is significantly higher (70%, IQR: 15-88% and 3.6%, IQR: 0-31%, respectively). In vitro all simulated reflux lead to a fall in pH whereas a corresponding decrease in impedance was only recognizable in the 4.5-mm plastic tubes. Acid reflux episodes in patients with HH are more frequently detected by pH-metry than by MII. Small volume reflux that does not lead to a decrease in impedance is the likely explanation for this phenomenon.

show abstract

“pH‐Only” Acid Reflux Events in Infants During Later Phases of the Feeding Cycle Are Less Acidic and Cleared More Efficiently Than Classic 2‐Phase Acid Reflux Events

Abstract: The lower acidity and more rapid clearance during 2ndPP and fasting suggest that POEs are likely to have a different clinical impact (compared with classic 2-phase AGER events) during later phases of the feeding cycle.

Cited by 12 publications

References 21 publications

Effects of Esophageal Acidification on Troublesome Symptoms: An Approach to Characterize True Acid GERD in Dysphagic Neonates

Effects of Esophageal Acidification on Troublesome Symptoms: An Approach to Characterize True Acid GERD in Dysphagic Neonates

Esophageal pH and Combined Impedance-pH Monitoring in Children

Small volume acid reflux in gastroesophageal reflux disease patients with hiatal hernia is only detectable by pH-metry but not by multichannel intraluminal impedance

Contact Info

Product

Resources

About