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Acid and bolus exposure in pediatric reflux disease according to the presence and severity of esophageal mucosal lesions

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Abstract

Purpose

The relationship between reflux index (RI) and bolus exposure parameters in multichannel intraluminal impedance (MII) has not been examined sufficiently among children. The significance of acid and bolus exposure in evaluating pediatric reflux disease (RD) was explored by focusing on mucosal lesions.

Methods

We conducted MII-pH on 28 patients (median age 8 years) with suspected RD. We assessed relationships between RI and bolus exposure indices, and also compared acid and bolus exposures across patients grouped by endoscopic esophageal mucosal lesions.

Results

RI correlated significantly with distal acid reflux events (r = 0.60), acid bolus exposure time (BET) (0.55), and bolus clearance time (BCT) (0.48). Significant differences were observed among the control, non-erosive RD (NERD), and erosive RD (ERD) groups in all acid and several bolus exposure indices (distal and proximal frequencies, and BCT), while no significant difference was apparent between NERD and ERD. Acid exposure tended to be more severe in high-grade than in low-grade ERD, while no similar tendency was found in any bolus parameters other than BCT.

Conclusions

MII-pH showed great potential for investigating the pathophysiology of pediatric RD, with RI revealing different correlations with variable bolus exposure indices. However, no specific parameters allowing precise discrimination between RDs or mucosal severities were identified.

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Abbreviations

BCT:

Bolus clearance time

BET:

Bolus exposure time

ERD:

Erosive reflux disease

GERD:

Gastroesophageal reflux disease

MII:

Multichannel intramural impedance

NERD:

Non-erosive reflux disease

RD:

Reflux disease

RI:

Reflux index

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Authors and Affiliations

  1. Department of Pediatric Surgery (E6), Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan

    Takeshi Saito, Keita Terui, Mitsuyuki Nakata, Shugo Komatsu & Hideo Yoshida

  2. Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan

    Masaya Uesato

Authors
  1. Takeshi Saito
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  2. Masaya Uesato
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  3. Keita Terui
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  4. Mitsuyuki Nakata
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  5. Shugo Komatsu
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  6. Hideo Yoshida
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Corresponding author

Correspondence to Takeshi Saito.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Saito, T., Uesato, M., Terui, K. et al. Acid and bolus exposure in pediatric reflux disease according to the presence and severity of esophageal mucosal lesions. Pediatr Surg Int 35, 887–893 (2019). https://doi.org/10.1007/s00383-019-04490-5

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  • DOI: https://doi.org/10.1007/s00383-019-04490-5

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