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The role of esophageal impedance in the diagnosis of gastro-esophageal reflux in infants and children

Wednesday, 27 April, 2011 - 16:30
Campus: Brussels Health Campus
Faculty: Medicine and Pharmacy
auditorium P. Brouwer
Silvia Salvatore
phd defence

The topic of this thesis focuses on clinical aspects
of physiologic gastro-esophageal reflux (GER)
and reflux disease (GERD), and concentrates on
different diagnostic possibilities. There is
increasing evidence that the clinical presentation
of GERD in infancy is peculiar as crying,
regurgitation, feeding, sleeping and respiratory
problems are commonly reported by parents both
in normal and GERD infants. In the first months
of life, lack of verbal expression, care-giver
interpretation and anxiety make the diagnosis of
GERD challenging. Cow’s milk allergy has
overlapping presentations. No current validated
question(naire) predicts the results of endoscopy,
pH-monitoring and multiple intraluminal
esophageal impedance in combination with pH
metry (MII-pH) or the response to treatment.
MII-pH allows the identification, quantification,
and localisation of acid, weakly acidic and alkaline
reflux. The definition of MII- GER is inadequate
for small infants and subjects with low baseline
impedance. Our data confirm that non-acid reflux
episodes are frequent in early infancy, in meal
and postprandial periods, are undetectable by
pH-monitoring but are associated with symptoms
and present in patients with esophagitis. Crying is
not more associated than cough with acid or
weakly acid reflux in the first months of life.
Empirical acid inhibitors treatment (for any kind
of presentation) in infancy is not supported by
MII-pH results. No investigation may actually be
considered as a “gold standard” diagnostic
technique of GERD although MII-pH seems to
approach this best.