Prolonged pH monitoring is of limited usefulness for gastroesophageal reflux
C. Ferreira, M. J. Lohoues, A. Bensoussan, S. Yazbeck, P. Brochu and C. C. Roy
Department of Pediatrics, Hopital Sainte-Justine, Montreal, Quebec, Canada.
OBJECTIVE--To assess the diagnostic value of pH monitoring. DESIGN--A
prospective study. SETTING--Pediatric university hospital serving as a
secondary and tertiary referral center. PARTICIPANTS--Thirty-eight infants,
aged 1 to 12 months, and 26 children, aged 13 months to 18 years, admitted
during a 2-year period because of clinically significant gastroesophageal
reflux (GER). INTERVENTIONS--Prolonged (20-hour) pH monitoring as well as
endoscopy and biopsy of the esophagus were carried out in all patients who,
on the basis of clinical data, were classified as having mild, moderate, or
severe GER disease. RESULTS--In the infant group, results of prolonged pH
monitoring were abnormal in 34 (89.5%). In the older group, results were
abnormal in less than half (11 [42.3%]) of the cases. In both groups, pH
monitoring data did not correlate with the severity of GER disease or of
esophagitis. Severity of GER disease was not predictive of esophagitis.
CONCLUSIONS--(1) Endoscopy and biopsy of the esophagus should be the first
procedures whenever there are clinical findings of moderate to severe GER
disease. (2) Monitoring of pH should be restricted to those patients
without a clear-cut history of GER disease.
