Skip to main content
SpringerLink
Log in

Esophageal pH and Impedance Monitoring

  • Chapter
  • First Online:
Pediatric Neurogastroenterology

Part of the book series: Clinical Gastroenterology ((CG))

  • 1896 Accesses

Abstract

pH monitoring and multichannel intraluminal impedance (pH-MII) are two catheter-based methods for measuring reflux. pH monitoring has been the gold standard test for measuring acid reflux and forms the basis for many therapeutic trials. Its primary limitations are that (1) it only can measure acid reflux yet misses non-acid reflux, (2) it cannot differentiate swallowed contents from reflux contents, and (3) it cannot accurately measure refluxate height. pH-MII can overcome all of these limitations yet data is lacking on how pH-MII changes clinical outcome beyond a standard pH probe. Additionally, there are no normal pH-MII values in children other than preterm infants and the interpretation of the studies is still time consuming both of which currently limit the clinical utility of the test. pH-MII has, however, replaced pH monitoring in diagnostic and therapeutic reflux trials and undoubtedly the limitations of the technology will be overcome with additional future studies. This chapter discusses in detail the benefits and limitations of these technologies, as well as some other new methods of reflux monitoring.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 249.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101:1900–20.

    Article  PubMed  Google Scholar 

  2. Sherman PM, Hassall E, Fagundes-Neto U, et al. A global, evidence-based consensus on the definition of gastroesophageal reflux disease in the pediatric population. Am J Gastroenterol. 2009;104:1278–95.

    Article  PubMed  Google Scholar 

  3. Spencer J. Prolonged pH recording in the study of gastro-oesophageal reflux. Br J Surg. 1969;56:912–4.

    Article  PubMed  CAS  Google Scholar 

  4. Rudolph C, Mazur L, Liptak G, et al. Guidlines for evaluation and treatment of gastroesophageal reflux in infants and children: recommendations of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr. 2001;32:S1–31.

    Article  PubMed  Google Scholar 

  5. Vandenplas Y, Belli D, Boige N. A standardized protocol for the methodology of esophageal pH monitoring and interpretation of the data for the diagnosis of gastro-esophageal reflux. J Pediatr Gastroenterol Nutr. 1992;14:467–71.

    Article  Google Scholar 

  6. Hirano I, Richter J. ACG practice guidelines: esophageal reflux testing. Am J Gastroenterol. 2007;102:668–85.

    Article  PubMed  Google Scholar 

  7. Strobel C, Byrne W, Ament M, Euler A. Correlation of esophageal lengths in children with height: application to the Tuttle test without prior esophageal manometry. J Pediatr. 1979;94:81–4.

    Article  PubMed  CAS  Google Scholar 

  8. Jolley SG, Tunell WP, Carson JA, Smith EI, Grunow J. The accuracy of abbreviated esophageal pH monitoring in children. J Pediatr Surg. 1984;19:848–54.

    Article  PubMed  CAS  Google Scholar 

  9. Tolia V, Kauffman RE. Comparison of evaluation of gastroesophageal reflux in infants using different feedings during intraesophageal pH monitoring. J Pediatr Gastroenterol Nutr. 1990;10:426–9.

    Article  PubMed  CAS  Google Scholar 

  10. Wo JM, Castell DO. Exclusion of meal periods from ambulatory 24-hour pH monitoring may improve diagnosis of esophageal acid reflux. Dig Dis Sci. 1994;39:1601–7.

    Article  PubMed  CAS  Google Scholar 

  11. Ter RB, Johnston BT, Castell DO. Exclusion of the meal period improves the clinical reliability of esophageal pH monitoring. J Clin Gastroenterol. 1997;25:314–6.

    Article  PubMed  CAS  Google Scholar 

  12. Tobin JM, McCloud P, Cameron DJ. Posture and gastro-oesophageal reflux: a case for left lateral positioning. Arch Dis Child. 1997;76:254–8.

    Article  PubMed  CAS  Google Scholar 

  13. Bell N, Karol MD, Sachs G, Greski-Rose P, Jennings DE, Hunt RH. Duration of effect of lansoprazole on gastric pH and acid secretion in normal male volunteers. Aliment Pharmacol Ther. 2001;15:105–13.

    Article  PubMed  Google Scholar 

  14. van Wijk MP, Benninga MA, Omari TI. Role of the multichannel intraluminal impedance technique in infants and children. J Pediatr Gastroenterol Nutr. 2009;48:2–12.

    Article  PubMed  Google Scholar 

  15. Cucchiara S, Staiano A, Gobio Casali L, Boccieri A, Paone F. Value of the 24 hour intraoesophageal pH monitoring in children. Gut. 1990;31:129–33.

    Article  PubMed  CAS  Google Scholar 

  16. Vandenplas Y, Franckx-Goossens A, Pipeleers-Marichal M, Derde M, Sacre-Smits L. Area under pH 4: advantages of a new parameter in the interpretation of esophageal pH monitoring data in infants. J Pediatr Gastroenterol Nutr. 1989;9:34–9.

    PubMed  CAS  Google Scholar 

  17. Wenner J, Johansson J, Johnsson F, Oberg S. Optimal thresholds and discriminatory power of 48-h wireless esophageal pH monitoring in the diagnosisof GERD. Am J Gastroenterol. 2007;102:1862–9.

    Article  PubMed  Google Scholar 

  18. Steiner SJ, Gupta SK, Croffie JM, Fitzgerald JF. Correlation between number of eosinophils and reflux index on same day esophageal biopsy and 24 hour esophageal pH monitoring. Am J Gastroenterol. 2004;99:801–5.

    Article  PubMed  Google Scholar 

  19. Black D, Haggitt R, Orenstein S, Whitington P. Esophagitis in infants. Morphologic histological diagnosis and correlation with measures of gastroesophageal reflux. Gastroenterology. 1990;98:1408–14.

    PubMed  CAS  Google Scholar 

  20. Boix-Ochoa J, Lafuenta J, Gil-Vernet J. Twenty-four hour esophageal pH monitoring in gastroesophageal reflux. J Pediatr Surg. 1980;15:74–8.

    Article  PubMed  CAS  Google Scholar 

  21. Cucchiara S, Santamaria F, Minella R, et al. Simultaneous prolonged recordings of proximal and distal intraesophageal pH in children with gastroesophageal reflux disease and respiratory symptoms. Am J Gastroenterol. 1995;90:1791–6.

    PubMed  CAS  Google Scholar 

  22. Euler A, Byrne W. Twenty-four-hour esophageal intraluminal pH probe testing: a comparative analysis. Gastroenterology. 1981;80:957–61.

    PubMed  CAS  Google Scholar 

  23. Sondheimer J. Continuous monitoring of distal esophageal pH: a diagnostic test for gastroesophageal reflux in infants. J Pediatr. 1980;96:804–7.

    Article  PubMed  CAS  Google Scholar 

  24. Vandenplas Y, Goyvaerts H, Helven R, et al. Gastroesophageal reflux, as assessed by 24-hour pH monitoring, in 509 healthy infants screened for SIDS-risk. Pediatrics. 1991;88:834–40.

    PubMed  CAS  Google Scholar 

  25. Salvatore S, Hauser B, Vandemaele K, Novario R, Vandenplas Y. Gastroesophageal reflux disease in infants: how much is predictable with questionnaires, pH-metry, endoscopy and histology? J Pediatr Gastroenterol Nutr. 2005;40:210–5.

    Article  PubMed  Google Scholar 

  26. Savarino E, Zentilin P, Tutuian R, et al. The role of nonacid reflux in NERD: lessons learned from impedance-pH monitoring in 150 patients off therapy. Am J Gastroenterol. 2008;103:2685–93.

    Article  PubMed  Google Scholar 

  27. Bredenoord AJ, Hemmink GJ, Smout AJ. Relationship between gastro-oesophageal reflux pattern and severity of mucosal damage. Neurogastroenterol Motil. 2009;21:807–12.

    Article  PubMed  CAS  Google Scholar 

  28. Vandenplas Y, Helven R, Goyvaerts H, et al. Reproducibility of continuous 24 hour oesophageal pH monitoring in infants and children. Gut. 1990;31:374–7.

    Article  PubMed  CAS  Google Scholar 

  29. Mahajan L, Wyllie RLO, et al. Reproducibility of 24-hour intraesophageal pH monitoring in pediatric patients. Pediatrics. 1998;101:260–3.

    Article  PubMed  CAS  Google Scholar 

  30. Nielsen R, Kruse-Andersen S, Husby S. Low reproducibility of 2 × 24-hour continuous esophageal pH monitoring in infants and children: a limiting factor for interventional studies. Dig Dis Sci. 2003;48:1495–502.

    Article  PubMed  Google Scholar 

  31. Hampton F, MacFadyen U, Simpson H. Reproducibility of 24 hour oeosophageal pH studies in infants. Arch Dis Child. 1990;65:1249–54.

    Article  PubMed  CAS  Google Scholar 

  32. McCallion WA, Gallagher TM, Boston VE, Potts SR. Effect of general anaesthesia on prolonged intraoesophageal pH monitoring. Arch Dis Child. 1995;73:235–8.

    Article  PubMed  CAS  Google Scholar 

  33. Malfroot A, Vandenplas Y, Verlinden M, Piepsz A, Dab I. Gastroesophageal reflux and unexplained chronic respiratory disease in infants and children. Pediatr Pulmonol. 1987;3:208–13.

    Article  PubMed  CAS  Google Scholar 

  34. Gunasekaran T, Gupta S, Gremse D, et al. Lansoprazole in adolescents with gastroesophageal reflux disease: pharmacokinetics, pharmacodynamics, symptom relief efficacy, and tolerability. J Pediatr Gastroenterol Nutr. 2002;35 Suppl 4:S327–35.

    Article  PubMed  CAS  Google Scholar 

  35. Lam H, Breumelhof R, Roelofs J, Van Berge Henegouwen G, Smout A. What is the optimal time window in a symptom analysis of 24-hour esophageal pressure and pH data? Dig Dis Sci. 1994;39:402–9.

    Article  PubMed  CAS  Google Scholar 

  36. Ward B, Wu W, Richter J, et al. Ambulatory 24-hour esophageal pH monitoring. Technology searching for a clinical application. J Clin Gastroenterol. 1986;8:59–67.

    Article  PubMed  Google Scholar 

  37. Singh S, Richter JE, Bradley LA, Haile JM. The symptom index. Differential usefulness in suspected acid-related complaints of heartburn and chest pain. Dig Dis Sci. 1993;38:1402–8.

    Article  PubMed  CAS  Google Scholar 

  38. Breumelhof R, Smout A. The symptom sensitivity index: a valuable additional parameter in 24-hour esophageal pH monitoring. Am J Gastroenterol. 1991;86:160–4.

    PubMed  CAS  Google Scholar 

  39. Weusten B, Roelofs J, Akkermans L, Van Berge Henegouwen G, Smout A. symptom-association probability: an improved method for symptom analysis of 24-hour esophageal pH data. Gastroenterology. 1994;107:1741–5.

    PubMed  CAS  Google Scholar 

  40. Taghavi S, Ghasedi M, Saberi-Firoozi M, et al. Symptom association probability and symptom sensitivity index: preferable but still suboptimal predictors of response to high dose omeprazole. Gut. 2005;54:1067–71.

    Article  PubMed  CAS  Google Scholar 

  41. Diaz S, Aymerich R, Clouse RE. The symptom association probability (SAP) is superior to the symptom index (SI) for attributing symptoms to gastroesophageal reflux: validation using outcome from laparoscopic antireflux surgery (LARS). Gastroenterology. 2002;122:A75.

    Article  Google Scholar 

  42. Wiener GJ, Tsukashima R, Kelly C, et al. Oropharyngeal pH monitoring for the detection of liquid and aerosolized supraesophageal gastric reflux. J Voice. 2009;23:498–504.

    Article  PubMed  Google Scholar 

  43. Ayazi S, Lipham JC, Hagen JA, et al. A new technique for measurement of pharyngeal pH: normal values and discriminating pH threshold. J Gastrointest Surg. 2009;13:1422–9.

    Article  PubMed  CAS  Google Scholar 

  44. Williams R, Ali G, Wallace K. Esophagopharyngeal acid regurgitation: dual pH monitoring criteria for its detection and insights into mechanisms. Gastroenterology. 1999;117:1051–61.

    Article  PubMed  CAS  Google Scholar 

  45. Golub JS, Johns III MM, Lim JH, DelGaudio JM, Klein AM. Comparison of an oropharyngeal pH probe and a standard dual pH probe for diagnosis of laryngopharyngeal reflux. Ann Otol Rhinol Laryngol. 2009;118:1–5.

    PubMed  Google Scholar 

  46. Chheda NN, Seybt MW, Schade RR, Postma GN. Normal values for pharyngeal pH monitoring. Ann Otol Rhinol Laryngol. 2009;118:166–71.

    PubMed  Google Scholar 

  47. Chiou E, Rosen R, Nurko S. Correlation of changes in oropharyngeal pH with gastroesophageal reflux events in children. J Pediatr Gastroenterol Nutr. 2009;49:E36.

    Google Scholar 

  48. Wiener G, Koufman J, Wu W, et al. Chronic hoarseness secondary to gastroesophageal reflux disease: documentation with 24-h ambulatory pH monitoring. Am J Gastroenterol. 1989;84:1503–8.

    PubMed  CAS  Google Scholar 

  49. Pandolfino JE, Richter JE, Ours T, Guardino JM, Chapman J, Kahrilas PJ. Ambulatory esophageal pH monitoring using a wireless system. Am J Gastroenterol. 2003;98:740–9.

    Article  PubMed  Google Scholar 

  50. Lacy B, Edwards S, Paquette L, Weiss J, Kelley M, Ornvold K. Tolerability and clinical utility of the Bravo pH capsule in children. J Clin Gastroenterol. 2009;43(6):514–9.

    Article  PubMed  Google Scholar 

  51. Fajardo NR, Wise JL, Locke GR, Murray JA, Talley NJ. Esophageal perforation after placement of wireless Bravo pH probe. Gastrointest Endosc. 2006;63:184–5.

    Article  PubMed  Google Scholar 

  52. Souza AL, Morley-Fletcher A, Nurko S, Rodriguez L. BRAVO wireless pH in children: is there an effect of anesthesia? Gastroenterology. 2009;136:A-510.

    Article  Google Scholar 

  53. Gunnarsdottir A, Stenstrom P, Arnbjornsson E. Wireless esophageal pH monitoring in children. J Laparoendosc Adv Surg Tech. 2008;18:443–7.

    Article  Google Scholar 

  54. Croffie J, Fitzgerald J, Molleson J, et al. Accuracy and tolerability of the Braco catheter-free pH capsule in patients between the ages of 4 and 18 years. J Pediatr Gastroenterol Nutr. 2007;45:559–63.

    Article  PubMed  Google Scholar 

  55. Gunnarsdottir A, Stenstrom P, Arnbjornsson E. 48-hour wireless oesophageal pH-monitoring in children: are two days better than one? Eur J Pediatr Surg. 2007;17:378–81.

    Article  PubMed  CAS  Google Scholar 

  56. Pandolfino J, Kahrilas P. Prolonged pH monitoring: Bravo capsule. Gastrointest Endosc Clin North Am. 2005;15:307–18.

    Article  Google Scholar 

  57. Toila V, Vandenplas Y. Systematic review: the extra-oesophageal symptoms of gastro-oesophageal reflux disease in children. Aliment Phamacol Ther. 2009;29:258–72.

    Article  Google Scholar 

  58. Vaezi MF, Richter JE, Stasney CR, et al. Treatment of chronic posterior laryngitis with esomeprazole. Laryngoscope. 2006;116:254–60.

    Article  PubMed  CAS  Google Scholar 

  59. Rosen R, Nurko S. The importance of multichannel intraluminal impedance in the evaluation of children with persistent respiratory symptoms. Am J Gastroenterol. 2004;99:2452–8.

    Article  PubMed  Google Scholar 

  60. Patterson N, Mainie I, Rafferty G, et al. Nonacid reflux episodes reaching the pharynx are important factors associated with cough. J Clin Gastroenterol. 2009;43:414–9.

    Article  PubMed  Google Scholar 

  61. Lopez-Alonso M, Moya MJ, Cabo JA, et al. Twenty-four-hour esophageal impedance-pH monitoring in healthy preterm neonates: rate and characteristics of acid, weakly acidic, and weakly alkaline gastroesophageal reflux. Pediatrics. 2006;118:e299–308.

    Article  PubMed  Google Scholar 

  62. Mitchell DJ, McClure BG, Tubman TR. Simultaneous monitoring of gastric and oesophageal pH reveals limitations of conventional oesophageal pH monitoring in milk fed infants. Arch Dis Child. 2001;84:273–6.

    Article  PubMed  CAS  Google Scholar 

  63. Sifrim D, Holloway R, Silny J, Tack J, Lerut A, Janssens J. Composition of the postprandial refluxate in patients with gastroesophageal reflux disease. Am J Gastroenterol. 2001;96:647–55.

    Article  PubMed  CAS  Google Scholar 

  64. Vela MF, Camacho-Lobato L, Srinivasan R, Tutuian R, Katz PO, Castell DO. Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux: effect of omeprazole. Gastroenterology. 2001;120:1599–606.

    Article  PubMed  CAS  Google Scholar 

  65. Hemmink GJ, Bredenoord AJ, Weusten BL, Monkelbaan JF, Timmer R, Smout AJ. Esophageal pH-impedance monitoring in patients with therapy-resistant reflux symptoms: ‘on’ or ‘off’ proton pump inhibitor? Am J Gastroenterol. 2008;103:2446–53.

    Article  PubMed  Google Scholar 

  66. Roman S, des Bruley Varannes S, Pouderoux P, et al. Ambulatory 24-h oesophageal impedance-pH recordings: reliability of automatic analysis for gastro-oesophageal reflux assessment. Neurogastroenterol Motil. 2006;18:978–86.

    Article  PubMed  CAS  Google Scholar 

  67. Hemmink GJ, Bredenoord AJ, Aanen MC, Weusten BL, Timmer R, Smout AJ. Computer analysis of 24-h esophageal impedance signals. Scand J Gastroenterol. 2011;46(3):271–6.

    Article  PubMed  Google Scholar 

  68. Imam H, Shay S, Ali A, Baker M. Bolus transit patterns in healthy subjects: a study using simultaneous impedance monitoring, videoesophagram, and esophageal manometry. Am J Physiol Gastrointest Liver Physiol. 2005;288:G1000–6.

    Article  PubMed  CAS  Google Scholar 

  69. Peter CS, Wiechers C, Bohnhorst B, Silny J, Poets CF. Detection of small bolus volumes using multiple intraluminal impedance in preterm infants. J Pediatr Gastroenterol Nutr. 2003;36:381–4.

    Article  PubMed  Google Scholar 

  70. Rosen R, Lord C, Nurko S. The sensitivity of multi-channel intraluminal impedance (MII) compared to pH probe in the detection of gastroesophgeal reflux in children. Clin Gastroenterol Hepatol. 2006;4:167–72.

    Article  PubMed  CAS  Google Scholar 

  71. Francavilla R, Magista AM, Bucci N, et al. Comparison of esophageal pH and multichannel intraluminal impedance testing in pediatric patients with suspected gastroesophageal reflux. J Pediatr Gastroenterol Nutr. 2010;50:154–60.

    Article  PubMed  Google Scholar 

  72. Wenzl TG, Moroder C, Trachterna M, et al. Esophageal pH monitoring and impedance measurement: a comparison of two diagnostic tests for gastroesophageal reflux. J Pediatr Gastroenterol Nutr. 2002;34:519–23.

    Article  PubMed  Google Scholar 

  73. Dalby K, Nielsen RG, Markoew S, Kruse-Andersen S, Husby S. Reproducibility of 24-hour combined multiple intraluminal impedance (MII) and pH measurements in infants and children. Evaluation of a diagnostic procedure for gastroesophageal reflux disease. Dig Dis Sci. 2007;52:2159–65.

    Article  PubMed  Google Scholar 

  74. Aanen MC, Bredenoord AJ, Numans ME, Samson M, Smout AJ. Reproducibility of symptom association analysis in ambulatory reflux monitoring. Am J Gastroenterol. 2008;103:2200–8.

    Article  PubMed  Google Scholar 

  75. Zerbib F, des Varannes SB, et al. Normal values and day-to-day variability of 24-h ambulatory oesophageal impedance-pH monitoring in a Belgian-French cohort of healthy subjects. Aliment Pharmacol Ther. 2005;22:1011–21.

    Article  PubMed  CAS  Google Scholar 

  76. Shay S, Tutuian R, Sifrim D, et al. Twenty-four hour ambulatory simultaneous impedance and pH monitoring: a multicenter report of normal values from 60 healthy volunteers. Am J Gastroenterol. 2004;99:1037–43.

    Article  PubMed  Google Scholar 

  77. Peter CS, Wiechers C, Bohnhorst B, Silny J, Poets CF. Influence of nasogastric tubes on gastroesophageal reflux in preterm infants: a multiple intraluminal impedance study. J Pediatr. 2002;141:277–9.

    Article  PubMed  Google Scholar 

  78. Rosen R, Furuta G, Fritz J, Donovan K, Nurko S. Role of acid and nonacid reflux in children with eosinophilic esophagitis compared with patients with gastroesophageal reflux and control patients. J Pediatr Gastroenterol Nutr. 2008;46:520–3.

    Article  PubMed  Google Scholar 

  79. Bredenoord AJ, Weusten BL, Timmer R, Conchillo JM, Smout AJ. Addition of esophageal impedance monitoring to pH monitoring increases the yield of symptom association analysis in patients off PPI therapy. Am J Gastroenterol. 2006;101:453–9.

    Article  PubMed  Google Scholar 

  80. Condino AA, Sondheimer J, Pan Z, Gralla J, Perry D, O’Connor JA. Evaluation of gastroesophageal reflux in pediatric patients with asthma using impedance-pH monitoring. J Pediatr. 2006;149:216–9.

    Article  PubMed  Google Scholar 

  81. Thilmany C, Beck-Ripp J, Griese M. Acid and non-acid gastro-esophageal refluxes in children with chronic pulmonary diseases. Respir Med. 2007;101:969–76.

    Article  PubMed  Google Scholar 

  82. Loots CM, Benninga MA, Davidson GP, Omari TI. Addition of pH-impedance monitoring to standard pH monitoring increases the yield of symptom association analysis in infants and children with gastroesophageal reflux. J Pediatr. 2009;154:248–52.

    Article  PubMed  Google Scholar 

  83. Rosen R, Levine P, Lewis J, Mitchell P, Nurko S. Reflux events detected by pH-MII do not determine fundoplication outcome. J Ped Gastroenterol Nutrit 2010 Mar;50(3):251–5.

    Google Scholar 

  84. Sifrim D, Dupont L, Blondeau K, Zhang X, Tack J, Janssens J. Weakly acidic reflux in patients with chronic unexplained cough during 24 hour pressure, pH, and impedance monitoring. Gut. 2005;54:449–54.

    Article  PubMed  CAS  Google Scholar 

  85. Jadcherla SR, Gupta A, Fernandez S, et al. Spatiotemporal characteristics of acid refluxate and relationship to symptoms in premature and term infants with chronic lung disease. Am J Gastroenterol. 2008;103:720–8.

    Article  PubMed  Google Scholar 

  86. Rosen R, Levine P, Lewis J, Mitchell P, Nurko S. Reflux events detected by pH-MII do not determine fundoplication outcome. J Pediatr Gastroenterol Nutr. 2010;50:251–5.

    Article  PubMed  Google Scholar 

  87. Mainie I, Tutuian R, Agrawal A, Adams D, Castell DO. Combined multichannel intraluminal impedance-pH monitoring to select patients with persistent gastro-oesophageal reflux for laparoscopic Nissen fundoplication. Br J Surg. 2006;93:1483–7.

    Article  PubMed  CAS  Google Scholar 

  88. Becker V, Bajbouj M, Waller K, Schmid RM, Meining A. Clinical trial: persistent gastro-oesophageal reflux symptoms despite standard therapy with proton pump inhibitors—a follow-up study of intraluminal-impedance guided therapy. Aliment Pharmacol Ther. 2007;26:1355–60.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

This work was supported in part by NIH NIDDK073713 (R.R.).

Author information

Authors and Affiliations

  1. Harvard Medical School, Center for Motility and Functional Gastrointestinal Disorders Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA, 02115, USA

    Rachel Rosen M.D., M.P.H.

  2. Center for Motility and Functional Gastrointestinal Disorders Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA, 02115, USA

    Eric Chiou M.D.

Authors
  1. Rachel Rosen M.D., M.P.H.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eric Chiou M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rachel Rosen M.D., M.P.H. .

Editor information

Editors and Affiliations

  1. Sainte-Justine Hospital, Department of Pediatrics, Division of Pediatric Gastroenterology, Université de Montréal, Montreal, H3T 1C5, Québec, Canada

    Christophe Faure

  2. Nationwide Children's Hospital, Division of Pediatric Gastroenterology, The Ohio State University, Columbus, 43205, Ohio, USA

    Carlo Di Lorenzo

  3. Gastroenterology and Neural Development, University College London, Institute of Child Health, Great Ormond Street Hospital for Children, London, WC1N 1EH, United Kingdom

    Nikhil Thapar

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Rosen, R., Chiou, E. (2013). Esophageal pH and Impedance Monitoring. In: Faure, C., Di Lorenzo, C., Thapar, N. (eds) Pediatric Neurogastroenterology. Clinical Gastroenterology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-709-9_12

Download citation

  • DOI: https://doi.org/10.1007/978-1-60761-709-9_12

  • Published:

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-60761-708-2

  • Online ISBN: 978-1-60761-709-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation