The prolonged measurement of the pH values close to the lower esophageal sphincter (LES) is considered the """"""""gold standard"""""""" in the diagnosis of gastroesophageal reflux (GER). A pH below 4.0 is considered indicative of GER. Conventional pH measurement detects only acidic GER, it can not detect a refluxate in the intermediate pH range (pH 4 -7.0) due to the proximity to normal esophageal pH (5-6.8), nor can it detect episodes of reflux during or after meals. Consequently a major amount of reflux episodes are concealed from pH monitoring. A recently developed procedure for the recording of gastrointestinal motility by means of multiple intraluminal impedance measurement (MII) is based on the registration of changes in the impedance during the passage of a bolus. Since food, saliva and gastric fluid are better electrical conductors than the muscular wall of the esophagus, a significant and specific change in impedance traces can be observed for each propulsive or retrograde flow. We propose using this new technology in a study of GER in pediatric patients with apnea. Newborn to 2-year-old children who were admitted to Columbus Children Hospital with apnea and referred for a pH probe will be eligible for participation. After consent, pneumogram leads will be connected to patients, and dual pH and impedance catheter will be placed via the nares into the distal esophagus. Placement will be verified by fluoroscopy. The pneumogram and impedance will be monitored simultaneously. The number, time duration, height, and pH of each reflux episode will be evaluated and correlated to the presence of apnea. We will compare the disease predictive ability between pH-metry and impedance method. We hypothesize that a significant proportion of GER is missed using the current pH dependent method. This study will improve current diagnostic approach, increase life expectancy and improve quality of life in children who suffer from apnea.
| Woodley, Frederick W; Fernandez, Soledad; Mousa, Hayat (2007) Diurnal variation in the chemical clearance of acid gastroesophageal reflux in infants. Clin Gastroenterol Hepatol 5:37-43 |
| Mousa, Hayat; Woodley, Frederick W; Metheney, Melissa et al. (2005) Testing the association between gastroesophageal reflux and apnea in infants. J Pediatr Gastroenterol Nutr 41:169-77 |
