RELIABILITY OF SHORT-TERM ESOPHAGEAL PH MONITORING VERSUS 24-HOUR STUDY

The child's discomfort and the cost of overnight hospitalization are c lear disadvantages of prolonged esophageal pH monitoring. The aim of t his study was to verify the reliability of short recording versus 24-h testing in a pediatric series with symptoms suggestive of gastroesoph ageal reflux (GER) disease. A 24-h pH monitoring performed on 160 pati ents with either gastroenterological symptoms (n = 61), respiratory pr oblems (n = 58), or emesis plus respiratory problems (n = 41) was revi ewed. Regardless of clinical presentation, children were also classifi ed according to age: <12 months (n = 39), 12-71 months (n = 81), and 7 2-168 months (n = 40). A diurnal fraction of 6 h, including at least 2 h after a meal, was compared to the entire 24-h recording in all grou ps with respect to the reflux index (RI) (sum of the periods with pH < 3.9 expressed as percentage of time) and reflux/h. RIs of >10% were co nsidered positive in patients <1 year of age, whereas RIs of >5% were considered positive in other age groups. Negative predictive values of the short recording RI ranged from 71 to 90%. Positive predictive val ues ranged from 50 to 83%; it was unreliable for children <12 mos (50% ) and patients with emesis plus respiratory problems (64%), who were, significantly, the youngest. Reflux/h values were not in agreement for the same groups. Absence of agreement was found if the absolute value of RI was considered. In conclusion, our data show that short-term re cordings may be used as an ambulatory screening test for GER in select ed children, being unreliable for patients <1 year of age and for thos e presenting with both gastroenterological and respiratory symptoms.