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Dual pH probe monitoring versus single pH probe monitoring in infants on milk feeds: the impact on diagnosis
  1. N Washingtona,
  2. P J Spensleya,
  3. C A Smitha,
  4. M Parkera,
  5. D Busha,
  6. S J Jacksona,
  7. L Kapilab,
  8. T Stephensonc,
  9. C Washingtond
  1. aDepartment of Surgery, University Hospital, Queen’s Medical Centre, Nottingham, NG7 2UH, UK, bDepartment of Paediatric Surgery, University Hospital, Queen’s Medical Centre, cDepartment of Child Health, University Hospital, Queen’s Medical Centre, dSchool of Pharmaceutical Sciences, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
  1. Dr N Washington, Department of Experimental Medicine, Astra Charnwood, Bakewell Road, Loughborough, Leicestershire LE11 5RH, UK. email: neena.washington{at}charnwood.gb.astra.com

Abstract

OBJECTIVES Oesophageal pH monitoring is the gold standard technique for the detection of gastro-oesophageal reflux in adults and children. A standard parameter used to define “abnormal” reflux is the percentage of recording time for which the gastric pH is < 4. This study investigated the relevance of this measure in infants on regular milk feeds whose gastric contents and refluxate will be neutral for most of the recording time.

METHODS Simultaneous oesophageal and gastric pH monitoring was carried out on all infants who were milk fed exclusively and admitted to hospital for suspected gastro-oesophageal reflux. In vitro studies were performed to establish the buffering capacities of the fruit juice, Dioralyte (a glucose electrolyte solution), breast milk, and milk formula feeds available on the paediatric wards.

RESULTS Complete sets of data were obtained from 30 babies with a mean age of 4 months. Gastric pH was ⩽ 4 for a mean (SEM) of 42.4 (4.9)% of the recording time. The mean (SEM) percentage time that oesophageal pH was < 4 for the total recording period was 6.89 (0.92)%. Recalculation of the percentage of time that the gastric pH was > 4 increased this value to 17.81 (2.46)%. Using a cut off point of 10%, 11 of the 30 babies would have been diagnosed positive for reflux using the conventional method; however, recalculation by ignoring the time for which gastric pH was high doubled this to 22 positive for reflux.

CONCLUSION Combined oesophageal and gastric pH monitoring greatly increases the number of positive results from tests in infants on regular milk feeds.

  • Reflux of neutral feeds is not easily detectable by conventional pH monitoring procedures

  • Conventional pH monitoring may severely underestimate the incidence of gastro-oesophageal reflux in babies

  • A dual probe approach, which monitors gastric acid and oesophageal pH, leads to a significantly higher diagnosis rate

  • oesophageal pH monitoring
  • gastro-oesophageal reflux
  • sudden infant death syndrome
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