[Esophageal pH-metry in children with recurrent respiratory events: diagnosis value of a day time esophageal pH monitoring]

Analyzing the effect of laparoscopy duration time on peroperative gastroesophageal reflux

Background/aim

Intraabdominal pressure (IAP) is one of the main reasons for gastroesophageal reflux (GER). This study investigates whether IAP during laparoscopic surgery leads to GER in a time-dependent manner.

Materials and methods

In a laparoscopy model, 15 mmHg IAP was created in 8 Wistar albino rats in the Trendelenburg position (TP). A 5 mm laparotomy was performed in the left lower abdominal region, and a 6 Fr catheter was placed intraabdominally. Air was insufflated into the abdominal cavity, and the pressure was kept constant at 15 mmHg. Esophageal pH alterations were measured by pH sticks for 4 h every 30 min.

Results

The basal median esophageal pH value was 9 (8–10), the value after placing the catheter was 9 (7–10) (P = 0.47), and the median pH value after placing the subjects in TP was 9 (8–10) (P = 0.70). In our experimental model, esophageal pH values were found to decrease significantly at the 150th minute in TP and at 15 mmHg IAP (P < 0.05). Two rats died: one at the 120th minute and the other at the 240th minute (P > 0.05).

Conclusion

Esophageal pH values decreased and continued to remain low following IAP increase and TP in this experimental rat model. Prolonged laparoscopic procedures can particularly lead to GER that requires instant recognition and rapid and appropriate intervention.

Influence of esophageal pH recording on physical activity in children

OBJECTIVES

Twenty-four-hour pH-metry represents the gold standard for the diagnosis of gastroesophageal reflux. Ambulatory esophageal pH recording provides a better reflection of occurrences under normal domestic living conditions, but it may influence physical activity. The aim of this study was to assess the influence of ambulatory esophageal pH recording on physical activity in children.

PATIENTS AND METHODS

This prospective study included 22 patients (18 boys, 4 girls) 3 to 15 years old (mean age 6.9 +/- 2.3 years) who had been referred for ambulatory pH-metry. The 24-hour physical activity was measured twice in each child using a triaxial accelerometer 1 week before or after pH-metry and during pH-metry. Levels of intensity of physical activity (low: sedentary activities; moderate: walking; high: intense activities such as jumping, running, and sport) were compared by the paired nonparametric Wilcoxon test.

RESULTS

Physical activity was 53% lower during 24-hour pH-metry than when it was not present (P < 0.0005). The duration of low-level physical activity was longer during pH-metry (84% vs 73%; P < 0.01). The duration of moderate-intensity and high-intensity physical activity was shorter during pH-metry (16% vs 24% and 0.2% vs 2.2%, respectively; P < 0.005 and P < 0.0001).

CONCLUSIONS

Ambulatory 24-hour esophageal pH recording substantially decreases physical activity, mainly high-level physical activity. Whether such changes in activity decrease the sensitivity of pH-metry and lead to false negative results in some children remains to be assessed.