The Role of 24-hour Multichannel Intraluminal Impedance–pH Monitoring in Pediatric Patients: A Single-Center Experience

Abstract

Background: Laryngopharyngeal reflux in children often presents with nonspecific respiratory symptoms, while conventional pH monitoring cannot detect non-acid events. Combined 24-hour multichannel intraluminal impedance–pH (MII–pH) monitoring detects acid and non-acid reflux, assesses their composition, and determines proximal extent. This study evaluated the diagnostic value of MII–pH monitoring in children with persistent respiratory complaints.

Methods: This study included children aged 0–18 years who underwent 24-hour MII–pH monitoring. Reflux parameters and symptom association probability (SAP) were analyzed. A study was defined as pathological if SAP ≥ 50% or reflux counts exceeded pediatric thresholds.

Main findings: The median number of reflux episodes was 50 by pH-metry and 113 by impedance, confirming that impedance detected more events. Liquid and gaseous reflux predominated, while mixed reflux was less common. The reflux index was low, and no significant difference was found between children with and without gastroesophageal reflux. Proximal migration reached the upper esophagus in over half of acid and 42% of weakly acid episodes. Gastroesophageal reflux was confirmed in 87.1% children and treatment was started in nearly all. Nineteen children with negative SAP still met pathological thresholds.

Principal conclusion: MII–pH monitoring provided higher diagnostic sensitivity than pH-metry alone and helped guide treatment in children with persistent respiratory symptoms.