The child with chronic cough: when does double-channel pH monitoring rule out gastroesophageal reflux

Richard Kitz, Peter Ahrens, Olaf Eickmeier, Hansjosef Boehles, Markus A. Rose

.

DOI: 10.4236/ojped.2011.13006                

Abstract

Background: gastroesophageal reflux (GER) plays a major role in the pathogenesis of pediatric chronic airway disease. Esophageal pH-monitoring (epHM) is the diagnostic gold standard for acid GER. To date, there are no cut-off values for chronically coughing children ruling out relevant GER. Methods: 24-hour, double-channel epHM was performed in 549 children (3 months to 16 years old) with chronic pulmonary disease. We stratified according to age as follows: ≤ 1.5 years, > 1.5 - 4 years, > 4 - 8 years, > 8 < 12 years and > 12 - 16 years. Following parameters were calculated for both channels: total number of reflux episodes, number of reflux episodes > 5 minutes, duration of the longest reflux episode, and reflux index. Results: according to the above given age classification, the median number of reflux episodes in the lower esophagus was 31, 27, 32, 34, and 42 and for the upper esophagus 20, 13, 15, 14, and 11 respectively. The median reflux index at the distal esophagus was 2.55, 2.1, 2.3, 2.15, and 1.9; at the upper esophagus it was 1.4, 1.0, 1.1, 0.9, and 0.6 respectively. Conclusions: our data contribute useful support to the evaluation of pediatric airway disease. We provide reference values for decisions in the exploration of children with airway disorders and suspected GER.

Keywords

Gastroesophageal Reflux; Pediatric Airway Diseases; pH-Monitoring; Chronic Aspiration

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Rudolph, C.D., Mazur, L.J., Liptak, G.S., Baker, R.D., Boyle, J.T., et al. (2001) Guidelines for evaluation and treatment of gastroesophageal reflux in infants and chil-dren: recommendations of the North American Society for Pediatric Gastroenterology and Nutrition. Journal of Pediatric Gastroenterology and Nutrition, 32, S1-S31. doi:10.1097/00005176-200100002-00001
[2]	Khoshoo, V., Le, T., Haydel, R.M., Landry, L. and Nelson, C. (2003) Role of gastroesophageal reflux in older children with persistent asthma. Chest, 123, 1008-1013. doi:10.1378/chest.123.4.1008
[3]	Bagucka, B., Badriul, H., Vandemaele, K., Troch, E. and Vandenplas, Y. (2000) Normal ranges of continuous pH-monitoring in the proximal esophagus. Journal of Pediatric Gastroenterology and Nutrition, 31, 244-247. doi:10.1097/00005176-200009000-00008
[4]	Sondheimer, J.M. and Haase, G.M. (1988) Simultaneous pH-recordings from multiple sites in children with and without distal gastroesophageal reflux. Journal of Pedi-atric Gastroenterology and Nutrition, 7, 46-51.
[5]	Gustafsson, P. and Tibbling, L. (1988) 24-hour oeso-phageal two-level pH-monitoring in healthy children and adolescents. Scand J Gastroenterol, 23, 91-94.
[6]	ESPGHAN—Working Group of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (1992) A standardized protocol for the methodology of esophageal pH-monitoring and interpretation of data for the diagnosis of gastroesophageal reflux. Journal of Pe-diatric Gastroenterology and Nutrition, 14, 467-471.
[7]	Ahrens, P., Haas, S. and Kitz, R. (2003) Standardization and optimization of 2-channel pH-monitoring in children with gastroesophageal reflux-associated pulmonary dis-ease. Monatsschrift Kinderheilkunde, 151, 1298-1305. doi:10.1007/s00112-003-0843-6
[8]	Dobhan, R. and Castell, D.O. (1993) Normal and abnor-mal proximal esophageal acid exposure: Results of am-bulatory dual-probe pH-monitoring. The American Journal of Gastroenterology, 88, 25-29.
[9]	Gorenstein, A., Levine, A., Boaz, M., Mandelberg, A. and Serour, F. (2003) Severity of acid gastroesophageal reflux assessed by pH metry: Is it associated with respiratory disease? Pediatric Pulmonology, 36, 330-334. doi:10.1002/ppul.10361
[10]	Harding, S.M., Guzzo, M.R. and Richter, J.E. (1999) 24-h Esophageal pH-Testing in Asthmatics. Chest, 115, 654-659. doi:10.1378/chest.115.3.654
[11]	Jaspersen, D., Kulig, M., Labenz, J., Leodolter, A., Lind, T., et al. (2003) Prevalence of extra-oesophageal mani-festations in gastro-oesophageal reflux disease: An analysis based on the ProGERD Study. Alimentary Pharmacology & Therapeutics, 17, 1515-1520. doi:10.1046/j.1365-2036.2003.01606.x
[12]	El-Serag, H.B., Gilger, M., Kuebeler, M. and Rabeneck, L. (2001) Extraesophageal association of gastroesophageal reflux disease in children without neurological defects. Gastroenterology, 121, 1294-1299. doi:10.1053/gast.2001.29545
[13]	Coletti, R.B., Christie, D.L. and Orenstein, S.R. (1995) Indications for pediatric esophageal pH-monitoring. Statement of the NASPGN. Journal of Pediatric Gas-troenterology and Nutrition, 21, 253-262. doi:10.1097/00005176-199510000-00002
[14]	Yüksel, H., Yilmaz, O., Kirmaz, C., Aydogldu, S. and Kasirga, E. (2006) Frequency of gastroesophageal reflux disease in nonatopic children with asthma-like airway disease. Respiratory Medicine, 100, 393-398.
[15]	Arana, A., Bagucka, B., Hauser, B., Hegar, B. and Urbain, D., et al. (2001) pH-Monitoring in the distal and proximal esophagus in symptomatic infants. Journal of Pediatric Gastroenterology and Nutrition, 32, 259-264. doi:10.1097/00005176-200103000-00005
[16]	Stordal, K., Johannesdottir, G.B., Bentsen, B.S., Knudsen, P.K. and Carlsen, K.C., et al. (2005) Acid suppression does not change respiratory symptoms in children with asthma and gastroesophageal reflux disease. Archives of Disease in Childhood, 90, 956-960. doi:10.1136/adc.2004.068890
[17]	Vandenplas, Y., Goyvaerts, H. and Helven, R. (1991) Gastroesophageal reflux, as measured by 24-hour pH-monitoring, in 509 healthy infants screened for risk of sudden infant death syndrome. Pediatrics, 88, 834-840.
[18]	Mitchell, D.J., McClure, B.G. and Tubman, T.R. (2001) Simultanous monitoring of gastric and oesophageal pH reveals limitations of conventional oesophageal pH-mo- nitoring in milk-fed infants. Archives of Disease in Childhood, 84, 273-276. doi:10.1136/adc.84.3.273
[19]	Wenzel, T.G., Moroder, C., Trachterna, M., Thomson, M. and Silny, J., et al. (2002) Esophageal pH-monitoring and impedance measurement: A comparison of two diagnostic tests for gastroesophageal reflux. Journal of Pediatric Gastroenterology and Nutrition, 34, 519-523. doi:10.1097/00005176-200205000-00009
[20]	Rosen, R., Lord, C. and Nurko, S. (2006) The sensitivity of multichannel intraluminal impedance and the pH probe in the evaluation of gastroesophageal reflux in children. Clinical Gastroenterology and Hepatology, 4, 167-172. doi:10.1016/S1542-3565(05)00854-2