Archives of Disease in Childhood, Vol 64, 1421-1426, Copyright © 1989 by Archives of Disease in Childhood.
Diagnostic accuracy of pH monitoring in gastro-oesophageal reflux
L Da Dalt, S Mazzoleni, G Montini, F Donzelli and F Zacchello
Department of Paediatrics, University of Padova, Italy.
One hundred and eleven children admitted with suspected gastro- oesophageal
reflux were studied, with 24 hour oesophageal pH monitoring as the first
line of investigation. Barium swallow examination, or oesophagoscopy, or
both, were carried out only in children with abnormal pH, who subsequently
had a trial of 1-12 months medical treatment. All patients were followed up
for eight months to two years. A final diagnosis of gastro-oesophageal
reflux was made in 41 patients, in all of whom the pH study was abnormal
(100% sensitivity). The final diagnosis was different in 70 patients; 66 of
these had a normal pH (94% specificity). All children with
gastro-oesophageal reflux were treated with drugs. All those with a
percentage reflux time of more than 27 and more than 20 episodes of reflux
lasting more than 5 minutes failed to improve and needed operation. We
conclude that monitoring of the oesophageal pH should be the first line of
investigation in patients with gastro-oesophageal reflux and should be used
together with clinical data and other investigations, to identify those
children who will need operation.
