SIMULTANEOUS PROLONGED RECORDINGS OF PROXIMAL AND DISTAL INTRAESOPHAGEAL PH IN CHILDREN WITH GASTROESOPHAGEAL REFLUX DISEASE AND RESPIRATORY SYMPTOMS

Objectives: To characterize both proximal and distal esophageal acid e xposure in children with gastroesophageal reflux-related respiratory d isease and to investigate the usefulness of dual-channel intraesophage al pH monitoring in these patients. Methods: Continuous simultaneous r ecording of distal and proximal esophageal pH was performed in 40 pati ents with gastroesophageal reflux disease and respiratory symptoms (wh eezing, nocturnal cough, obstructive bronchitis) (age range 3-168 mont hs) (group A), in 20 patients with reflux disease alone (age range 7-1 56 months) (group B), and in 14 controls (age range 5-108 months) (gro up C). Results: (expressed as median a SD) 1) The two groups of patien ts did not differ with regard to distal and proximal esophageal acid e xposure (percentage of reflux) during both the total recording period [distal, A: 9.2 +/- 4, B: 10.7 +/- 7 (NS), C: 1.9 +/- 1.0; and proxima l, A: 4.8 +/- 3.3, B: 4.0 +/- 3.3 (NS), C: 1.0 +/- 0.7] and during nig httime [distal, A: 8.0 +/- 6.2, B: 10.4 +/- 6.1 (NS), C: 0.9 +/- 0.65; and proximal, A: 3.72 +/- 3, B: 3.6 +/- 3.0 (NS), C: 0.75 +/- 0.45]. 2) The two groups did not differ with regard to the ratio between prox imal and distal esophageal acid exposure during both total and nocturn al periods of analysis. 3) No significant correlation was found betwee n distal and proximal esophageal acid exposure during total and noctur nal recording periods. 4) In patients with reflux-related respiratory disease, the respiratory symptomatic index was significantly higher du ring distal esophageal acid exposure alone (47.0 +/- 28.6%) than durin g simultaneous reflux at the two esophageal levels (26.9 +/- 27%) (p < 0.05). Furthermore, reflux episodes associated with respiratory sympt oms reached lower pH values than those in patients without symptoms at the two recording sites. Conclusions: Gastroesophageal reflux into th e proximal esophagus does not discriminate between patients with reflu x disease alone and those with reflux disease complicated by respirato ry symptoms. Symptoms of asthma in reflux patients appear to be elicit ed more by a reflex mechanism than by aspiration of gastric refluxate into the airways. Intraesophageal acidification seems to be involved i n eliciting respiratory symptoms related to reflux disease, and prolon ged intraesophageal two-level pH measurement does not seem to be usefu l in the approach to patients with reflux disease associated with resp iratory symptoms.