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Reflux esophagitis and esophageal pH monitoring in distressed infants

par Vandenplas, Yvan;Verghote, Marc ;Kaufman, Leonard;Hauser, Bruno
Référence International pediatrics, 19, 2, page (98-102)
Publication Publié, 2004

Article révisé par les pairs

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Résumé :

Acid reflux and/or esophagitis may be responsible for inconsolable crying in infants. We evaluated prospectively the presence of occult acid reflux disease, esophagitis and the accuracy of pH monitoring in the prediction of esophagitis in a population of distressed infants. A 24-hour esophageal pH monitoring with an antimony electrode and an upper gastro-intestinal tract endoscopy with grasp biopsies were performed on 60 distressed infants, aged 1 to 6 months, after failure of a cow's milk elimination diet. A 24-hour esophageal pH monitoring was considered abnormal (> 5% of investigation time with a pH < 4.0) in 20 (33%) babies and histological esophagitis was present in 26 (43%). In the infants with histological esophagitis, the reflux index (percentage of the investigation time with a pH < 4.0) was > 5% in 10 (38%). Histology of the esophagus was normal in 10 (50%) children with an abnormal pH monitoring. The mean reflux index was similar in the group with (4.66%) and without esophagitis (5.00) (p=NS). The sensitivity and specificity to predict esophagitis with a reflux index of 5.0% or more was 38.5 and 70.6, respectively. There was not a reflux index that could be related to a clinical useful sensitivity and specificity to predict esophagitis. Acid gastro-esophageal reflux disease (GER) and/or histological esophagitis were diagnosed in 33% and 43% of distressed infants, respectively. The reflux index does not accurately predict esophagitis and normal histology does not accurately exclude acid gastro-esophageal reflux disease. Esophageal pH monitoring and endoscopy provide additional information.