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Sempértegui-Cárdenas PX, Toro-Monjaraz EM, Zárate-Mondragón FE, Ignorosa-Arellano K, Cadena-León JF, Cervantes-Bustamante R, Montijo-Barrios E, Ramírez-Mayans JA. A new formula proposal for placing pH-impedance catheters in pediatric patients. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2024; 89:347-353. [PMID: 38862360 DOI: 10.1016/j.rgmxen.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/08/2023] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Esophageal pH-impedance monitoring is a tool for diagnosing gastroesophageal reflux in children. The position of the pH catheter is essential for a reliable reading and the current formulas for calculating catheter insertion length are not completely accurate. The aim of the present study was to develop a new formula for adequate insertion of the pH catheter. MATERIAL AND METHODS A cross-sectional study was conducted on children that underwent pH-impedance monitoring and later radiographic control, to calculate the correct catheter insertion length. The documented variables were age, sex, weight, height, naris to tragus distance, tragus to sternal notch distance, sternal notch to xiphoid process distance, and initial insertion length determined by the Strobel and height interval formulas. A multivariate regression analysis was carried out to predict the final insertion length. Regression ANOVA and Pearson's adjusted R-squared tests were performed. RESULTS Forty-five pH-impedance studies were carried out, 53% of which were in males. The age and weight variables were not normally distributed. In the initial regression model, the variables that did not significantly correlate with the final insertion length were: sex (P 0.124), length determined by the Strobel or height interval formulas (P 0.078), naris to tragus distance (P 0.905), and tragus to sternal notch distance (P 0.404). The final equation: 5.6 + (height in cm * 0.12) + (sternal notch to xiphoid process distance * 0.57) produced an R2 of 0.93 (P 0.000). CONCLUSIONS This formula can be considered a valid option for placement of the pH-impedance monitoring catheter in pediatrics.
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Affiliation(s)
- P X Sempértegui-Cárdenas
- Servicio de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - E M Toro-Monjaraz
- Servicio de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, Mexico City, Mexico.
| | - F E Zárate-Mondragón
- Servicio de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - K Ignorosa-Arellano
- Servicio de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - J F Cadena-León
- Servicio de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - R Cervantes-Bustamante
- Servicio de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - E Montijo-Barrios
- Servicio de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - J A Ramírez-Mayans
- Servicio de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, Mexico City, Mexico
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Pop RS, Pop D, Chiperi LE, Nechita VI, Man SC, Dumitrașcu DL. Utility of the Post-Reflux Swallow-Induced Peristaltic Wave Index and Mean Nocturnal Baseline Impedance for the Diagnosis of Gastroesophageal Reflux Disease Phenotypes in Children. CHILDREN (BASEL, SWITZERLAND) 2024; 11:773. [PMID: 39062223 PMCID: PMC11275132 DOI: 10.3390/children11070773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/19/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024]
Abstract
(1) Objectives: Assessment of novel impedance parameters such as the post-reflux swallow-induced peristaltic wave (PSPW) index and mean nocturnal baseline impedance (MNBI) have been proposed to enhance the accuracy of gastroesophageal reflux disease (GERD) diagnosis. We aimed to evaluate the clinical value of MNBI and the PSPW index in discerning different phenotypes of GERD in children. (2) Methods: We conducted a prospective, observational study that included 49 children aged 5-18 years, referred for MII-pH monitoring due to negative endoscopy and persisting gastroesophageal reflux symptoms despite acid-suppressant treatment. The PSPW index and MNBI were assessed along with conventional metrics. (3) Results: Using a receiver operating characteristic (ROC) curve analysis, MNBI (AUC 0.864) and the PSPW index (AUC 0.83) had very good performance in differentiating between non-erosive reflux disease (NERD) and functional phenotypes. The PSPW index (AUC 0.87) discriminated better between functional heartburn (FH) and reflux hypersensitivity (RH) compared to the MNBI (AUC 0.712). A PSPW cut-off value of 65% provided a sensitivity of 76.9% and a specificity of 90% in distinguishing FH and RH. The PSPW index (AUC 0.87) proved to have better performance than the MNBI (AUC 0.802) in differentiating between FH and non-FH patients. MNBI diagnosed FH with a sensitivity of 84% and a specificity of 80.6% at a cut-off value of 2563 Ω. (4) Conclusions: The PSPW index and MNBI are useful to distinguish between GERD phenotypes in pediatric patients.
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Affiliation(s)
- Radu Samuel Pop
- 3rd Department of Pediatrics, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400217 Cluj-Napoca, Romania; (D.P.); (S.C.M.)
| | - Daniela Pop
- 3rd Department of Pediatrics, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400217 Cluj-Napoca, Romania; (D.P.); (S.C.M.)
- 3rd Pediatric Clinic, Clinical Emergency Hospital for Children, 400217 Cluj-Napoca, Romania
| | - Lăcrămioara Eliza Chiperi
- Department of Pediatrics, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540136 Târgu Mureș, Romania;
| | - Vlad-Ionuț Nechita
- Department of Medical Informatics and Biostatistics, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
| | - Sorin Claudiu Man
- 3rd Department of Pediatrics, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400217 Cluj-Napoca, Romania; (D.P.); (S.C.M.)
- 3rd Pediatric Clinic, Clinical Emergency Hospital for Children, 400217 Cluj-Napoca, Romania
| | - Dan Lucian Dumitrașcu
- 2nd Department of Internal Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania;
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Strachan T, Ďuriček M, Ferenc P, Kunč P, Vorčák M, Bánovčin P, Javorka M, Fábry J. Simple Formula for pH/Impedance Probe Positioning in Children-Time to Update Standard Practice? Indian J Pediatr 2024; 91:131-136. [PMID: 36070168 DOI: 10.1007/s12098-022-04347-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/22/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop a novel formula for pH probe placement with adequate accuracy. METHODS Children (3-18 y) undergoing pH-metry were prospectively evaluated. Their height and corrected pH probe position under X-ray (2 vertebrae above the diaphragm) was recorded and the linear-regression analysis was performed to derive a novel formula. Its accuracy was checked on an additional group of prospectively included children. The success rate of a newly developed formula was estimated and compared to the performance of previously used formulae. The difference in the suggested placement of the probe (cm from nostrils) was calculated. RESULTS Based on 670 children with pH probe placed under X-ray, the following formula was developed using the linear-regression analysis: L = 0.184x + 4.4 (cm) (L = probe placement depth, x = body height). Its accuracy was confirmed on additional 111 children resulting in almost 85% success rate. The formula showed significant difference in the suggested placement from formulae used previously: +4.9 ± 0.8 cm, +2.4 ± 0.1 cm, +0.7 ± 0.6 cm, +1.1 ± 0.4 cm, +1.8 ± 0.3 cm, +2.2 ± 0.5 cm from the one by the Strobel, Moreau, Wilson, Nowak, Staiano-Clouse formulae, and the GOSH table with the calculated success rates of 1.8%, 43.2%, 65.8%, 77.5%, 65.8% and 54.1%, respectively. A table suggesting placement depth based on the body height was developed. CONCLUSION The present formula provides 85% success of pH probe placement in children ≥ 3 y suggesting its use in routine practice. More data are needed to confirm that probe adjustment under X-ray is unnecessary.
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Affiliation(s)
- Tomáš Strachan
- National Institute of Children's Tuberculosis and Respiratory Diseases, Dolny Smokovec, Slovakia
| | - Martin Ďuriček
- Clinic of Internal Medicine - Gastroenterology, Jessenius Faculty of Medicine in Martin (JFM CU), JFM CU, Comenius University in Bratislava, Kollárova 2, Martin, 036 01, Slovakia.
| | - Peter Ferenc
- National Institute of Children's Tuberculosis and Respiratory Diseases, Dolny Smokovec, Slovakia
| | - Peter Kunč
- National Institute of Children's Tuberculosis and Respiratory Diseases, Dolny Smokovec, Slovakia
| | - Martin Vorčák
- Radiology Clinic, Jessenius Faculty of Medicine in Martin (JFM CU), JFM CU, Comenius University in Bratislava, Bratislava, Slovakia
| | - Peter Bánovčin
- Clinic of Internal Medicine - Gastroenterology, Jessenius Faculty of Medicine in Martin (JFM CU), JFM CU, Comenius University in Bratislava, Kollárova 2, Martin, 036 01, Slovakia
| | - Michal Javorka
- Department of Physiology, Jessenius Faculty of Medicine in Martin (JFM CU), JFM CU, Comenius University in Bratislava, Bratislava, Slovakia
| | - Jaroslav Fábry
- Clinic of Children TB and Respiratory Diseases, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, National Institute of Children Tuberculosis and Respiratory Diseases, Dolny Smokovec, Slovakia
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Woodley FW. Editing Multichannel Intraluminal Impedance-pH Tracings to Reduce Non-reflux-related Esophageal Acidification. J Neurogastroenterol Motil 2024; 30:121-122. [PMID: 38173165 PMCID: PMC10774796 DOI: 10.5056/jnm23164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Affiliation(s)
- Frederick W Woodley
- Center for Neurogastroenterology and Motility Disorders, Nationwide Children's Hospital, Columbus, OH, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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Vandecruys A, Huysentruyt K, Van De Maele K, Vandenplas Y. How Best to Estimate Insertion Length of Multichannel Intraluminal Impedance pH Probes in Children. J Pediatr 2023; 259:113449. [PMID: 37150291 DOI: 10.1016/j.jpeds.2023.113449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 03/17/2023] [Accepted: 04/30/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To assess the reliability of the KidZ Health Castle formula (KHC-F) to determine the correct probe position of a multichannel intraluminal impedance pH. STUDY DESIGN A retrospective cohort study was performed on 222 children between 1 month and 18 years of age undergoing multichannel intraluminal impedance pH. The primary outcome was the comparison of the pH sensor location determined by the KHC-F with the radiological target position. The margin of error was defined as 1 cm from the target position. Performance of the KHC-F and existing formulas was determined via the percentage with a correct position, mean error, 95% limits of agreement (Bland-Altman plots), and Spearman correlation. A post hoc analysis was performed with an updated KHC-F v2, subtracting -0.5 cm from the KHC-F. RESULTS Positioning with KHC-F was correct in two-thirds of the participants, with a very strong correlation (ρ = 0.91) with the target position. Bland-Altman plots showed good agreement between KHC-F and target position (mean error of -0.44 cm, lower limit -3.2 cm, upper limit 2.3 cm). A post hoc analysis with the KHC-F v2 showed a correct positioning in 74% of patients. Comparison with other formulas showed a stronger performance of KHC-F and KHC-F v2 on correct positioning, mean error, and 95% limits of agreement. CONCLUSIONS The KHC-F leads to reliable results. KHC-F v2 outperforms all other existing formulas in children, thereby reducing the need for repositioning and the amount of x-ray exposure. The age distribution of the sample may be a limitation, as well as the retrospective nature of the study.
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Affiliation(s)
- Amber Vandecruys
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | - Koen Huysentruyt
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | - Kristel Van De Maele
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | - Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium.
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Rosado-Arias Y, Toro-Monjaraz EM, Cervantes-Bustamante R, Zarate-Mondragon F, Cadena-Leon J, Ignorosa-Arellano K, Loredo-Mayer A, Ramírez-Mayans J. Low Mean Nocturnal Baseline Impedance is Associated With a Pathological Acid Exposure Time in Children. J Pediatr Gastroenterol Nutr 2022; 74:215-220. [PMID: 34694265 DOI: 10.1097/mpg.0000000000003331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND The baseline impedance (BI) and the mean nocturnal baseline impedance (MNBI) serve as markers of mucosal integrity in patients with pathologic acid exposure time (AET). This work aims to investigate the association between the BI and MNBI with the AET in children. METHODOLOGY A retrospective study was performed in children ≤18 years old with suspicion of gastroesophageal reflux disease who underwent both endoscopy and pH-impedance monitoring (pH-MII). Esophagitis was graded according to the Los Angeles classification. The pathological AET was determined depending on the age (≥5% in patients >1 year and ≥10% in those ages ≤1 year). For the BI, 60 s measurements were taken every 4 h, and for the MNBI, 3 10 min measurements were taken between 1.00 and 3:00 am; then, they were averaged. The means of BI and MNBI were compared with each other, with the AET, and other variables. RESULTS Sixty-eight patients were included, 25% of patients presented pathological AET. The mean of the MNBI was higher than BI in channels 6 (2195 vs 1997 Ω, P = 0.011) and 5 (2393 vs 2228 Ω, P = 0.013). BI and MNBI at channel 6 were lower in patients with pathological AET than in those with normal AET (1573 vs 2138 Ω, P = 0.007) and (1592 vs 2396 Ω, P = 0.004), respectively. CONCLUSIONS Children with pathological AET had lower impedance values than those with normal AET. BI and MNBI measurements should be part of the routine MII-pH assessment in children.
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Affiliation(s)
- Yolainis Rosado-Arias
- Departement of Gastroenterology and Nutrition Department, at Instituto Nacional de Pediatria, Mexico, Mexico
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7
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Tinawi GK, Stringer MD. Esophageal length in children: Reference data and a novel predictive equation. Clin Anat 2021; 35:288-295. [PMID: 34766376 DOI: 10.1002/ca.23808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 11/09/2022]
Abstract
Minimal information exists on the length of the child's esophagus, namely the distance from the cricopharyngeus to the esophagogastric junction (EGJ). We aimed to investigate the relationship between esophageal length (EL) and the age, height, and weight of the child. Children undergoing upper gastrointestinal endoscopy between February 2019 and May 2021 at our institution were prospectively audited. Children with anatomical esophageal disorders were excluded. Endoscopic distances from the incisors to the cricopharyngeus and EGJ were obtained, and novel predictive equations derived to predict EL. Intra-observer agreement for endoscopic measurements showed an intra-class correlation coefficient of 0.99. A total of 290 children aged 0.4-17.3 years were included in the analysis; they were divided into a model development cohort (n = 261) and a model validation cohort (n = 29). Measured EL correlated best with height (r = 0.92) as compared to age (r = 0.90) or weight (r = 0.83). The optimal equation for predicting EL was 0.156 × height (cm) - 1.336 (adjusted R2 = 0.841); this had a success rate of 76% in the validation cohort. The optimal equation for predicting distance from incisors to EGJ was 0.199 × height (cm) + 6.470 (adjusted R2 = 0.889); this had a success rate of 69% in the validation cohort. This is the first study to report a predictive equation for estimating esophageal length in children. Accurate prediction of esophageal length may assist with clinical esophageal procedures in children such as nasogastric and pH probe placement.
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Affiliation(s)
- Georges K Tinawi
- Department of Paediatric Surgery, Wellington Children's Hospital, Wellington, New Zealand
| | - Mark D Stringer
- Department of Paediatric Surgery, Wellington Children's Hospital, Wellington, New Zealand.,Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
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Quitadamo P, Tambucci R, Mancini V, Cristofori F, Baldassarre M, Pensabene L, Francavilla R, Di Nardo G, Caldaro T, Rossi P, Mallardo S, Maggiora E, Staiano A, Cresi F, Salvatore S, Borrelli O. Esophageal pH-impedance monitoring in children: position paper on indications, methodology and interpretation by the SIGENP working group. Dig Liver Dis 2019; 51:1522-1536. [PMID: 31526716 DOI: 10.1016/j.dld.2019.07.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/02/2019] [Accepted: 07/20/2019] [Indexed: 12/11/2022]
Abstract
Multichannel intraluminal impedance pH (MII-pH) monitoring currently represents the gold standard diagnostic technique for the detection of gastro-esophageal reflux (GER), since it allows to quantify and characterize all reflux events and their possible relation with symptoms. Over the last ten years, thanks to its strengths and along with the publication of several clinical studies, its worldwide use has gradually increased, particularly in infants and children. Nevertheless, factors such as the limited pediatric reference values and limited therapeutic options still weaken its current clinical impact. Through an up-to-date review of the available scientific evidence, our aim was to produce a position paper on behalf of the working group on neurogastroenterology and acid-related disorders of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) on MII-pH monitoring technique, indications and interpretation in pediatric age, in order to standardise its use and to help clinicians in the diagnostic approach to children with GER symptoms.
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Affiliation(s)
- Paolo Quitadamo
- Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Naples, Italy; Department of Translational Medical Science,"Federico II", University of Naples, Italy.
| | - Renato Tambucci
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Valentina Mancini
- Department of Pediatrics and Neonatology, Saronno Hospital, Saronno, Italy
| | - Fernanda Cristofori
- Department of Pediatrics, Giovanni XXIII Hospital, Aldo MoroUniversity of Bari, Bari, Italy
| | - Mariella Baldassarre
- Department of Biomedical Science and Human Oncology-neonatology and Nicu section, University "Aldo Moro", Bari, Italy
| | - Licia Pensabene
- Department of Medical and Surgical Sciences, Pediatric Unit, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Ruggiero Francavilla
- Department of Pediatrics, Giovanni XXIII Hospital, Aldo MoroUniversity of Bari, Bari, Italy
| | - Giovanni Di Nardo
- NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Tamara Caldaro
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paolo Rossi
- Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy
| | - Saverio Mallardo
- Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy
| | - Elena Maggiora
- Neonatology and Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Annamaria Staiano
- Department of Translational Medical Science,"Federico II", University of Naples, Italy
| | - Francesco Cresi
- Neonatology and Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Silvia Salvatore
- Pediatric Department, Ospedale "F. Del Ponte", University of Insubria, Varese, Italy
| | - Osvaldo Borrelli
- Division of Neurogastroenterology and Motility, Department of Paediatric Gastroenterology, UCL Institute ofChild Health and Great OrmondStreet Hospital, London, UK
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Arcos-Machancoses JV, García Tirado D, Vila Miravet V, Pujol Muncunill G, Pinillos Pisón S, Martín de Carpi J. What is the best method for calculating the optimal position of an esophageal pH probe in children? Dis Esophagus 2019; 32:5393324. [PMID: 30888408 DOI: 10.1093/dote/doz014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In assessment of distal esophageal pH, the sensor of the probe should be placed above the upper border of the lower esophageal sphincter. There are several methods to estimate the distance from the nose where the probe should be fixed according to the patient's height. We studied the accuracy of these methods. Data of patients who underwent esophageal monitoring were collected prospectively. The esophageal pH electrode was set with the aid of fluoroscopy in all cases, considering the location recommended by the current guideline. Esophageal probe position and anthropometric data of each patient were recorded. We compared the actual esophageal pH electrode distance from the nose with that estimated by Nowak's, Strobel's, Staiano-Clouse's, and Moreau's formulae and the Great Ormond Street Hospital (GOSH) table. A total of 98 patients were included, with ages ranging from 2 months to 19 years old. The highest success rate (67%) for all age groups was achieved by Nowak's formula (3.2 + 0.2 × height in cm). Considering only children under 3 years old, the GOSH table reached the highest-yet probably overestimated-fraction of adequate predictions. A corrected Staiano and Clouse's formula (4.28 + 0.191 × height in cm) had a slightly lower success rate than Nowak's due to a poorer performance in younger children. In conclusion, Nowak's formula is the most accurate regardless of age. It can help reduce radiation due to systematic fluoroscopy, as well as the subsequent manipulation of the esophageal probe. However, it still leads to pH sensor misplacements in more than one-third of children. In consequence, a confirmatory X-ray is advisable even after using the formula.
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Affiliation(s)
- J V Arcos-Machancoses
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Sant Joan de Déu Hospital, Barcelona, Catalonia, Spain
| | - D García Tirado
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Sant Joan de Déu Hospital, Barcelona, Catalonia, Spain
| | - V Vila Miravet
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Sant Joan de Déu Hospital, Barcelona, Catalonia, Spain
| | - G Pujol Muncunill
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Sant Joan de Déu Hospital, Barcelona, Catalonia, Spain
| | - S Pinillos Pisón
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Sant Joan de Déu Hospital, Barcelona, Catalonia, Spain
| | - J Martín de Carpi
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Sant Joan de Déu Hospital, Barcelona, Catalonia, Spain
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Mutalib M, Rawat D, Lindley K, Borrelli O, Perring S, Auth MKH, Thapar N. BSPGHAN Motility Working Group position statement: paediatric multichannel intraluminal pH impedance monitoring-indications, methods and interpretation. Frontline Gastroenterol 2017; 8:156-162. [PMID: 28839903 PMCID: PMC5558281 DOI: 10.1136/flgastro-2016-100796] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/18/2017] [Accepted: 02/23/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Combined pH-impedance monitoring has been suggested as the investigation of choice for diagnosing gastro-oesophageal reflux in children. Although it is superior to oesophageal pH monitoring in detecting all types of reflux episodes (acid, weakly acidic and alkaline) with the ability to evaluate symptom association with reflux events, it is still limited by the lack of true paediatric normal value and the high cost involved (equipment and personnel). OBJECTIVE To produce a position statement on behalf of the Motility Working Group of the British Society of Paediatric Gastroenterology, Hepatology and Nutrition on the indications and practical application of combined oesophageal pH-impedance monitoring in children. METHODS Up-to-date review of available evidence. RESULTS This document provides a practical guide to clinician on indications, methods and results interpretation of paediatric multichannel intraluminal impedance pH (MII-pH). CONCLUSIONS MII-pH is increasingly used by paediatricians as the diagnostic tool for assessing gastro-oesophageal reflux disease and symptom association. There is wide variation in paediatric practice and a need for standardised practice.
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Affiliation(s)
- Mohamed Mutalib
- Paediatric Gastroenterology Department, Evelina London Children's Hospital, London, UK
| | - David Rawat
- Paediatric Gastroenterology Department, Royal London Hospital, London, UK
| | - Keith Lindley
- Paediatric Gastroenterology Department, Great Ormond Street Hospital, London, UK
| | - Osvaldo Borrelli
- Paediatric Gastroenterology Department, Great Ormond Street Hospital, London, UK
| | - Steve Perring
- Department of Medical Physics, Poole Hospital, Poole, UK
| | - Marcus K H Auth
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Nikhil Thapar
- Paediatric Gastroenterology Department, Great Ormond Street Hospital, London, UK
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Molina Caballero AY, Villar Varela ME, Pérez Martínez A, Ayuso González L, Hernández Martín S, Goñi Orayen C. Colocación de sondas de pHmetría mediante fórmula relacionada con la talla. ¿Es un método aplicable a los adultos? GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 39:261-4. [DOI: 10.1016/j.gastrohep.2015.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 08/04/2015] [Accepted: 08/10/2015] [Indexed: 11/16/2022]
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