Background and aims: combined multichannel intraluminal impedance and pH-monitoring (MII/pH) is a new technique identifying refluxes irrespective of acidity and detecting their duration, proximal extent and pH. These features are important when studying gastroesophageal-reflux-disease (GERD) in infants, in which weakly acid refluxes are prevalent. Clinical application of MII/pH is uncommon yet, owing to lack of reference values and difficult interpretation of the variables obtained. Aim of the present study was to investigate the relationship between MII-pH results and clinical outcome on a sample of GERD infants. Methods: infants (age: 0-3 months) with GERD symptoms were studied with MII/pH and submitted to a follow-up consisting in clinical examinations and structured interviews to parents at 3-6-9-12-18-24-36 months to evaluate the presence of symptoms and the therapy effects. Results: 54 patients completed the follow-up (32M; age 33.69±21.78 days; weight 3465.13±791.08 gr.; length 52.08±3.55 cm). 22 and 15 patients were still symptomatic at the age of 6 and 9 months, without difference in MII/pH values between symptomatic and non symptomatic infants. The 12 infants that were still symptomatic at the age of 12 months showed a higher bolus exposure index (BEI) with respect to the healed patients (2.63±1.72% vs 1.72±1.05; p=0.029). Conclusions: MII-pH in first months of life could be useful to identify patients with high risk of presenting GER symptoms for more than 1 year. BEI is a pH independent variable with a significant relationship with symptoms duration. Our data highlight the clinical relevance of MII/pH-detected weakly acidic refluxes in GERD infant.

Objective: Neonatal gastroesophageal reflux (GER) is primarily due to a transient motility disorder and characterized by a prevalence of weakly acid refluxes. Drug management, where necessary, must set out to reduce the number of refluxes besides correct their acidity. Prokinetics could be of assistance in this respect, though the evidence in favor of their efficacy and safety is still far from sufficient. In this randomized controlled study, the action of domperidone, a prokinetic antidopaminergic drug with little effect on the central nervous system, was evaluated in newborns with symptomatic GER. Study Design: Combined multichannel intraluminal impedance and pH measuring for 24 h was carried out in 13 newborns receiving 0.3 mg per kg domperidone per os at the eighth and the sixteenth hour, and 13 controls. Each newborn was compared to the control nearest in postconceptional age. Result: GER episodes per hour increased significantly compared to the baseline in the domperidone group (4.06±1.16 vs 2.8±1.42; P =0.001) and were shorter (16.68±4.49 vs 20.18±7.83 s; P =0.043), whereas there were no differences in the maximu proximal extent reached by the refluxes (3.37±0.45 vs 3.34±0.94 channels; P =0.894) and their pH (4.72±0.69 vs 4.60±1.17; P =0.634). Conclusion: This paradoxical increase in the number of GER episodes could be the expression of a domperidone-induced amplification of the motor incoordination of the neonatal gastroesophageal tract. Doubt is thus cast on the efficacy of prokinetics in this age bracket, especially in view of their adverse effects as described in the literature.

Introduction. The state of wakefulness/sleep is known to influence oesophageal acid exposure and the number of acid refluxes, whereas it is uncertain whether the same is true of the non-acid refluxes that predominate in the newborn.

Background: Gastroesophageal reflux disease (GERD) in newborn is characterized by a protean symptomatology that includes excessive irritability and crying, frequent vomiting and regurgitations, feeding problems, rumination, apnea, aspiration pneumonia, failure to thrive and anemia. The aim of this study was to investigate the relationship between symptoms and gastroesophageal activity in infants with gastroesophageal reflux. Methods: To evaluate gastroesophageal tract activity we have combined multichannel intraluminal electrical impedance (MII) and pH monitoring with epigastric impedance (EGI) in 30 neonates with suspected GERD. This combination of three methods provides complementary, simultaneous data from the esophagus and stomach. MII detected reflux episodes were characterized by time of occurrence, duration, height, pH, gastric filling state and gastric emptying velocity. Relations between GER features, gastric emptying data and symptoms observed during the trial were statistically evaluated. Results: During 90 hours of combined recording 248 reflux events (15.3% acid) were detected in 30 neonates. 99 episodes were associated to symptoms. The average (SD) gastric emptying time was 148.2(21.9) minutes with a T½ of 56.2(15.1) minutes. The main gastric emptying velocity was 0.69(0.12) radians. The number of GER and acid GER per tracing were respectively 8.3(1.0) and 1.3(0.8). Crying(24) was associated to long and acid reflux events. Regurgitations(13) and vomiting(8) were associated to high level of GER and gastric filling level. Rumination(31) was increased during high level GERs. Irritability(20) was observed in both: low level and high duration reflux episodes. In the end a correlation between apnea(3) and acid refluxes was observed. Conclusions: Our data suggest a relationship between GER symptoms and gastroesophageal activity. These findings could be relevant to practice of giving neonatal GERD therapeutic treatments on the grounds of infants symptoms. Further studies are necessary to establish the impact of our results and a possible clinical utilization.

Background: Gastroesophageal reflux (GER) is a common and relevant clinical problem in infants. Relationships between GER and gastric emptying are still unclear. The multiple intraluminal impedance (MII) technique is based on the intraluminal measurement of electrical impedance between 6 electrodes during a bolus passage. On the basis of the temporal sequence of impedance changes, it can be identified whether a change in impedance is caused by a bolus moving in an antegrade (swallow) or a retrograde (reflux) direction. Epigastric impedance (EGI) is a technique to evaluate gastric emptying by measuring modifications in the impedance value in the gastric area by means of 4 skin electrodes. Aim of this study was to investigate the relationship between GER and gastric emptying by multiple intraluminal impedance and epigastric impedance in infants.Methods: 9 term infants with GER simptoms were evaluated by MII (Sleuth Recorder Sandhill) connected to an intraluminal 6 channel probe and by EGI (Akern) simultaneously. Data were collected for 180 min after the ingestion of a milk meal for two time for each patient. Refluxate events were detected by MII as impedance changes in the distal channels proceeded sequentially to the more proximal channels. From the epigastric impedance emptying curve was calculated for each refluxate event the level of gastric emptying and the emptying velocity (figure). Data were compared by using Pearson correlation.Results: 18 simultaneously analysis were performed for a total of 54 hours recording. 163 refluxate events were detected. The average emptying time and the number of reflux events were respectively 132±34(minutes), 9.1±3.3(events/ analysis). The frequency of refluxate events was significantly correlated with the emptying velocity (r=0.93; p<0.05). No correlations were found between GER and gastric emptying time or level of gastric emptying.Conclusion: Gastric emptying in GER infants has not a linear trend. Delayed emptying periods with an increasing of refluxate events are followed by fast emptying periods with decreasing of refluxate events. This variability suggests that a dismotility disorder interesting all the gastroesophageal tract might be relevant in infants affected by GER.