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Esophageal pH and Esophagitis
Esophagitis in Distressed Infants: Poor Diagnostic Agreement Between Esophageal pH Monitoring and Histopathologic Findings. Heine RG, Cameron DJ, Chow CW, et al. J Pediatr (Jan 2002); 140:14-9.
One hundred twenty-five infants with persistent distress and clinical symptoms suggestive of gastro-esophageal reflux (GER) and esophagitis were studied with 24-hour esophageal pH monitoring and upper GI biopsies. Thirty-two (25.6%) had esophagitis; 11 of these also had gastritis or duodenitis. Only 9 of the 32 infants with esophagitis had abnormal esophageal pH monitoring. Another group of 23 infants had abnormal pH monitoring, but no esophagitis. Diagnostic agreement between pH monitoring and esophageal histologic features was poor.
Comment. This study points out another limitation of esophageal pH monitoring: the inability of this test to reliably predict the presence of esophagitis. This is probably because almost 90% for GER episodes in neonates are non-acidic [ref. Wenzl et al, J Pediatr Gastroenterol Nutr. 1999; 28:423-28]. Since esophageal pH monitoring can’t reliably detect either GER or esophagitis in neonates, I can’t help but wonder why we would continue to subject infants to this test. If you need yet another reason to give up doing esophageal pH studies in neonates, see 3-012.
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