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Oesophageal pH monitoring and reflux oesophagitis in irritable infants

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Abstract

Acid reflux and/or oesophagitis may be responsible for inconsolable crying in infants. We evaluated prospectively the presence of acid reflux disease, oesophagitis and the accuracy of pH monitoring in the prediction of oesophagitis in a population of irritable infants. A 24-h oesophageal pH monitoring with a glass electrode and an upper gastro-intestinal tract endoscopy with grasp biopsies were performed in 60 irritable infants, aged 1 to 6 months, not responding to cow’s milk elimination. The 24-h oesophageal pH monitoring was considered abnormal in 40/60 (66%) babies and histological oesophagitis was present in 26/60 (43%). In the infants with histological oesophagitis, the reflux index (% of the investigation time with a pH <4.0) was >5% in 18/26 (69%). Histology of the oesophagus was normal in 22 of the 40 (55%) infants with an abnormal pH monitoring. The mean reflux index in the group with oesophagitis (12.20%) was significantly higher than in the group with normal histology (8.74) ( P =0.036), although there was an important overlap. The sensitivity and specificity to predict oesophagitis with a reflux index of 5.0% or more was 69.2 and 35.3, respectively. There was not a reflux index which could be related to a clinically useful sensitivity and specificity to predict oesophagitis. Conclusion:acid gastro-oesophageal reflux disease and/or histological oesophagitis were diagnosed in 66% and 43% of irritable infants, respectively. There was no relation between symptoms and abnormal pH metry or oesophagitis; however, the reflux index does not accurately predict oesophagitis and normal histology does not accurately exclude acid gastro-oesophageal reflux disease. Oesophageal pH monitoring and endoscopy provide additional information.

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Abbreviations

GOR :

gastro-oesophageal reflux

RI :

reflux index

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Authors and Affiliations

  1. Department of Paediatrics, Academic Children’s Hospital, Free University of Brussels, Laarbeeklaan 101, 1090 , Brussels, Belgium

    Yvan Vandenplas, Hegar Badriul & Bruno Hauser

  2. Centre Hospitalier Régional de Namur, Namur, Belgium

    Marc Verghote

  3. Department of Biostatistics, Academic Children’s Hospital, Free University of Brussels, Brussels, Belgium

    Leonard Kaufman

Authors
  1. Yvan Vandenplas
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  2. Hegar Badriul
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  3. Marc Verghote
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  4. Bruno Hauser
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  5. Leonard Kaufman
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Correspondence to Yvan Vandenplas.

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Vandenplas, Y., Badriul, H., Verghote, M. et al. Oesophageal pH monitoring and reflux oesophagitis in irritable infants. Eur J Pediatr 163, 300–304 (2004). https://doi.org/10.1007/s00431-004-1403-3

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  • DOI: https://doi.org/10.1007/s00431-004-1403-3

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