Skip to main content

Advertisement

SpringerLink
Log in

Combined multichannel intraluminal impedance and pH monitoring assists the diagnosis of sliding hiatal hernia in children with gastroesophageal reflux disease

  • Original Article—Alimentary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

The role of combined multichannel intraluminal impedance and pH monitoring (MII-pH) in diagnosing sliding hiatal hernia in gastroesophageal reflux disease (GERD) children remains unclear. We aimed to explore the clinical efficacy of MII-pH as a supplement diagnostic method for sliding hiatal hernia.

Methods

A total of 104 symptomatic GERD children [mean ± standard deviation (SD) age = 4.5 ± 5.5 years] were recruited. All of them were diagnosed as GERD with and without sliding hiatal hernia by barium and/or esophagogastroduodenoscopy study. All subjects received 24 h MII-pH monitoring to test the efficacy of this new modality.

Results

Sixteen children were diagnosed to have sliding hiatal hernia, and nine (56.3 %) of them received fundoplication. None of non-hiatal hernia children were indicated for fundoplication [risk difference (RD) 0.56; P < 0.001]. Impedance probes detected more reflux episodes than pH-probe in the whole study population (mean ± SD = 62.1 ± 47.8 vs. 47.8 ± 48.1 episodes; P = 0.02, paired t test). Due to the presence of pH-only reflux, the reflux episodes detected by impedance probes is less than that by pH probe in sliding hiatal hernia children (mean ± SD = 49.2 ± 78.9 vs. 103.7 ± 60.4 episodes; P = 0.01, paired t test). Ratio of reflux episodes detected by pH-probe to that by impedance probes >1 was more frequently noted in sliding hiatal hernia children than non-sliding hiatal hernia children (Odds ratio 58.33, P < 0.001). The sensitivity and specificity of this diagnostic tool to predict sliding hiatal hernia in GERD children are 93.8 and 79.6 %, respectively.

Conclusions

Ratio of reflux episodes detected by pH-probe to that by impedance probes >1 demonstrated by MII-pH study is a good screening test of sliding hiatal hernia in GERD children.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

EGD:

Esophagogastroduodenoscopy

GERD:

Gastroesophageal reflux disease

MII-pH:

Multichannel intraluminal impedance and pH monitoring

UGI:

Upper gastrointestinal

References

  1. Gorenstein A, Cohen AJ, Cordova Z, Witzling M, Krutman B, Serour F. Hiatal hernia in pediatric gastroesophageal reflux. J Pediatr Gastroenterol Nutr. 2001;33:554–7.

    Article  CAS  PubMed  Google Scholar 

  2. Jones MP, Sloan SS, Rabine JC, Ebert CC, Huang CF, Kahrilas PJ. Hiatal hernia size is the dominant determinant of esophagitis presence and severity in gastroesophageal reflux disease. Am J Gastroenterol. 2001;96:1711–7.

    Article  CAS  PubMed  Google Scholar 

  3. Avidan B, Sonnenberg A, Schnell TG, Chejfec G, Metz A, Sontag SJ. Hiatal hernia size, Barrett’s length, and severity of acid reflux are all risk factors for esophageal adenocarcinoma. Am J Gastroenterol. 2002;97:1930–6.

    Article  PubMed  Google Scholar 

  4. Wyman JB, Dent J, Holloway RH. Changes in oesophageal pH associated with gastro-oesophageal reflux. Are traditional criteria sensitive for detection of reflux? Scand J Gastroenterol. 1993;28:827–32.

    Article  CAS  PubMed  Google Scholar 

  5. Sifrim D, Castell D, Dent J, Kahrilas PJ. Gastro-oesophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid, and gas reflux. Gut. 2004;53:1024–31.

    Article  CAS  PubMed  Google Scholar 

  6. Shay S, Richter J. Direct comparison of impedance, manometry, and pH Probe in detecting reflux before and after a meal. Dig Dis Sci. 2005;50:1584–90.

    Article  PubMed  Google Scholar 

  7. Antoniou SA, Koch OO, Antoniou GA, Asche KU, Kaindlstorfer A, Granderath FA, et al. Similar symptom patterns in gastroesophageal reflux patients with and without hiatal hernia. Dis Esophagus. 2012. doi:10.1111/j.1442-2050.2012.01368.x.

    Google Scholar 

  8. Weigt J, Malfertheiner P. Small volume acid relux in gastroesophageal reflux disease patients with hiatal hernia is only dectable by pH-metry but not by multichannel intraluminal impedance. Dis Esophagus. 2012. doi:10.1111/j.1442-2050.2012.01379.x.

  9. Johnson LF, Demeester TR. Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux. Am J Gastroenterol. 1974;62:325–32.

    CAS  PubMed  Google Scholar 

  10. Kahrilas PJ, Quigley EM. Clinical esophageal pH recording: a technical review for practice guideline development. Gastroenterology. 1996;110:1982–96.

    Article  CAS  PubMed  Google Scholar 

  11. Vandenplas Y, Rudolph CD, Di Lorenzo C, Hassall E, Liptak G, Mazur L, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2009;49:498–547.

    Article  PubMed  Google Scholar 

  12. Nelson SP, Chen EH, Syniar GM, Christoffel KK. One-year follow up of symptoms of gastroesophageal reflux during infancy. Pediatrics. 1998;102:e67.

    Article  CAS  PubMed  Google Scholar 

  13. Ashorn M, Ruuska T, Karikoski R, Laippala P. The natural course of gastroesophageal reflux disease in children. Scand J Gastroenterol. 2002;37:638–41.

    Article  CAS  PubMed  Google Scholar 

  14. Ruigómez A, Wallander MA, Lundborg P, Johansson S, Rodriguez LA. Gastroesophageal reflux disease in children and adolescents in primary care. Scand J Gastroenterol. 2010;45:139–46.

    Article  PubMed  Google Scholar 

  15. Fass J, Silny J, Braun J, Heindrichs U, Dreuw B, Schumpelick V, et al. Measuring esophageal motility with a new intraluminal impedance device. First clinical results in reflux patients. Scand J Gastroenterol. 1994;29:693–702.

    Article  CAS  PubMed  Google Scholar 

  16. Katzka DA, Paoletti V, Leite L, Castell DO. Prolonged ambulatory pH monitoring in patients with persistent gastroesophageal reflux disease symptoms: testing while on therapy identifies the need for more aggressive anti-reflux therapy. Am J Gastroenterol. 1996;91:2110–3.

    CAS  PubMed  Google Scholar 

  17. Shaw GY. Application of ambulatory 24-hour multiprobe pH monitoring in the presence of extraesophageal manifestations of gastroesophageal reflux. Ann Otol Rhinol Laryngol Suppl. 2000;184:15–7.

    CAS  PubMed  Google Scholar 

  18. Pilic D, Fröhlich T, Nöh F, Pappas A, Schmidt-Choudhury A, Köhler H, et al. Detection of gastroesophageal reflux in children using combined multichannel intraluminal impedance and pH measurement: data from the German Pediatric Impedance Group. J Pediatr. 2011;158:650–4.

    Article  PubMed  Google Scholar 

  19. Blonski W, Hila A, Vela MF, Castell DO. An analysis of distal esophageal impedance in individuals with and without esophageal motility abnormalities. J Clin Gastroenterol. 2008;42:776–81.

    Article  PubMed  Google Scholar 

  20. Ghezzi M, Silvestri M, Guida E, Pistorio A, Sacco O, Mattioli G, et al. Acid and weakly acid gastroesophageal refluxes and type of respiratory symptoms in children. Respir Med. 2011;105:972–8.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by a grant from National Taiwan University Hospital (NTUH.100-M1671).

Conflict of interest

The authors have no potential, perceived, or real conflict of interest.

Author information

Authors and Affiliations

  1. Department of Pediatrics, National Taiwan University Children’s Hospital and College of Medicine, National Taiwan University, No. 8, Chung Shan South Road, Taipei, 100, Taiwan

    Jia-Feng Wu, Hong-Yuan Hsu, Mei-Hwei Chang & Yen-Hsuan Ni

  2. Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan

    Wei-Chung Hsu

  3. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Ping-Huei Tseng & Hsiu-Po Wang

Authors
  1. Jia-Feng Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wei-Chung Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ping-Huei Tseng
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hsiu-Po Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hong-Yuan Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mei-Hwei Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yen-Hsuan Ni
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yen-Hsuan Ni.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wu, JF., Hsu, WC., Tseng, PH. et al. Combined multichannel intraluminal impedance and pH monitoring assists the diagnosis of sliding hiatal hernia in children with gastroesophageal reflux disease. J Gastroenterol 48, 1242–1248 (2013). https://doi.org/10.1007/s00535-013-0750-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00535-013-0750-0

Keywords

Search

Navigation