ABSTRACT
Background and study aims: Gastro-oesophageal reflux disease [GERD] is incriminated as a cause of non-asthmatic infantile wheeze. To date, no diagnostic test is considered standard for GERD-related airway reflux diagnosis. Oesophageal combined multiple channel intraluminal impedance and pH [MII-pH] monitoring is proposed to be a sensitive tool for evaluation of all GERD including infantile wheeze. We aimed to determine the GERD prevalence amongst wheezy infants in the first year of life using combined MII-pH versus pH monitoring alone and evaluate the sensitivity and specificity of objective MII-pH monitoring parameters in GERD-associated infantile wheeze diagnosis compared to those of lipid-laden macrophage index [LLMI]
Patients and methods: Thirty-eight wheezy infants below 1 year of age were evaluated for GERD using oesophageal combined MII-pH monitoring and LLMI
Results: Totally, 60.5% of cases had abnormal MII-pH; only 7.9% of them had abnormal pH monitoring. LLMI was significantly higher in wheezy infants with abnormal MII-pH than infants with normal MII-pH monitoring [112 +/- 88 versus 70 +/- 48; P = 0.036]. The current definitions of abnormal MII-pH study, reflux index >/= 10% and distal reflux episodes >/= 100, had low sensitivity [23%] but high specificity [100% and 96%, respectively] in GERD-related aspiration diagnosis defined by LLMI >/= 100. Using ROC curves, bolus contact time >/= 2.4% and proximal reflux episodes >/= 46 had 61% and 54% sensitivity and 64% and 76% specificity, respectively, in GERD-related aspiration diagnosis
Conclusion: Combined MII-pH is superior to pH monitoring in reflux-associated infantile wheeze diagnosis. Objective data including proximal reflux episodes and bolus contact time should be combined with the current parameters used in reflux-associated infantile wheeze diagnosis