Prevalence of gastroesophageal reflux disease in children with extraesophageal manifestations using combined-video, multichannel intraluminal impedance-pH study

Abstract

BACKGROUND Gastroesophageal reflux disease (GERD) might be either a cause or comorbidity in children with extraesophageal problems especially as refractory respiratory symptoms, without any best methods or criterion for diagnosing it in children. AIM To evaluate the prevalence of extraesophageal GERD using conventional and combined-video, multichannel intraluminal impedance-pH (MII-pH), and to propose novel diagnostic parameters. METHODS The study was conducted among children suspected of extraesophageal GERD at King Chulalongkorn Memorial Hospital between 2019 and 2022. The children underwent conventional and/or combined-video MII-pH. The potential parameters were assessed and receiver operating characteristic was used for the significant parameters. RESULTS Of 51 patients (52.9% males), aged 2.24 years were recruited. The common problems were cough, recurrent pneumonia, and hypersecretion. Using MII-pH, 35.3% of the children were diagnosed with GERD by reflux index (31.4%), total reflux events (3.9%), and symptom indices (9.8%) with higher symptom recorded in the GERD group (94 vs 171, P = 0.033). In the video monitoring group ( n = 17), there were more symptoms recorded (120 vs 220, P = 0.062) and more GERD (11.8% vs 29.4%, P = 0.398) by symptom indices . Longest reflux time and mean nocturnal baseline impedance were significant parameters for diagnosis with receiver operating characteristic areas of 0.907 ( P = 0.001) and 0.726 ( P = 0.014). CONCLUSION The prevalence of extraesophageal GERD in children was not high as expected. The diagnostic yield of symptom indices increased using video monitoring. Long reflux time and mean nocturnal baseline impedance are novel parameters that should be integrated into the GERD diagnostic criteria in children.

Diagnostic Utility of pH-MII Monitoring in Preschool Children with Recurrent Wheeze and Suspected Gastroesophageal Reflux Disease: A Prospective Study

“…Our findings underscore the diagnostic utility of pH-MII monitoring in preschool children with recurrent wheezing, revealing a significantly higher proportion of GERD compared to pH-metry alone. This aligns with recent studies that have emphasized the limitations of pH-metry in detecting WAR [14][15][16][17], further highlighting the importance of pH-MII in providing a more accurate representation of reflux events and their associations with clinical symptoms. Notably, we observed that GERD was diagnosed in 71% of cases using pH-MII compared to only 12% with pH-metry alone.…”

The Utility of Novel pH-Impedance Monitoring Parameters (PSPW Index and MNBI) in Pediatric Gastroesophageal Reflux Disease Phenotypes—A Systematic Review

“…Eiamkulbutr et al [ 25 ] described MNBI as having a good discriminatory ability to diagnose GERD, with an area under the curve (AUC) of 0.726 (95% CI: 0.581–0.870). The study identified a cutoff value of 1466 ohms for MNBI, yielding a sensitivity of 50.0% and a specificity of 33.33%.…”

“…Despite their promise, the utility of the PSPW index and MNBI in pediatric GERD remains incompletely understood. While studies in adult populations have demonstrated their potential diagnostic value, the pediatric population presents unique challenges and considerations that may influence the applicability and interpretation of these metrics [ 25 ]. As such, a comprehensive evaluation of the existing literature is warranted to assess the evidence supporting the use of the PSPW index and MNBI in diagnosing GERD in children.…”

Proton Pump Inhibitors in Pediatric Gastroesophageal Reflux Disease: A Systematic Review of Randomized Controlled Trials

“…The prevalence of GERD is difficult to establish because of the heterogeneity of the diagnostic criteria used in different studies [ 3 , 4 , 5 ]. The disease could occur in 25.5% of babies aged 0–1 month, decreasing to 1.1–1.6% by 1 year of age [ 3 , 5 ] and ranging from 0.9% to 18.8% [ 5 , 6 ] in childhood and adolescence.…”