P243 Impedance-ph monitoring in children with nonacid gastroesophageal reflux

Background and aims Multichannel intraluminal impedance (MII) is a pH-independent method of assessing gastroesophageal reflux. We aimed to evaluate the diagnostic accuracy of MII-pH as compared with conventional pH monitoring in detecting reflux events and symptom association. Materials and methods A retrospective study was performed. For patients suspected of GER, without anti-reflux treatment, examined through MII-pH and with normal pH-metry (differently defined according to age), the following were analysed: the number of weekly acid reflux (WAR) episodes, the number of weekly alkaline reflux (AlkR) episodes, the symptomatic correlation between reflux and symptom by analysing the probability of symptomatic association (SAP), the extension of reflux episodes within the level of proximal oesophagus recorded in percentage. Results 35 children (20 male, 15 female), age between 1 month and 11 years (22 infants), were recorded. The reasons for recommending pH-metry associated with electrical impedance were recurrent vomiting and growth failure in 22 cases, recurrent wheezing associated with chronic vomiting in 7 cases and recurrent wheezing or chronic cough in 6 cases. All patients showed in most cases an extension of the reflux episodes at a proximal oesophagus level. WAR was increased in the case of 23 children, 9 positive symptomatic correlation (4 with acid reflux) and 4 increased WAR as well as positive symptomatic correlation. AlkR episodes were absent in all children. The therapeutic recommendations were: hypoallergenic diet in 17 cases, prokinetic agents and/or alginates for 19 patients and histamine 2 receptor antagonists (H2RAs) or proton pump inhibitors (IPPs) in 8 cases. Conclusion The association of electrical impedance to pH-metry provides new criteria in establishing pathological GER diagnosis, and allows an accurate therapeutic approach in the case of these children.