Analysis of multichannel intraluminal impedance and phmonitoring values in children with cerebral palsy laspghan working group comparative multicenter study
- Autores
- Lorenzo, Cristina; Zubiri, Cecilia; Zosi, Anabella; Miculan, Sandro; Bigliardi, Roman; Neder, Daniela; Rocca, Ana; Cohen Sabban, Judith; Manterola, Manuela; Savia, Maria de Los Angeles; Mortarini, Maria; Weinschelbaum, Renata; Saps, Miguel; Boggio, Christian; Plante, Verónica; Arcucci, Soledad; Perez, Luis Orlando; Toro Mojaraz, Erick; Ruiz Hernandez, Carlos; Tahan, Soraia; Fontenele Soares, Ana Cristina
- Año de publicación
- 2024
- Idioma
- inglés
- Tipo de recurso
- documento de conferencia
- Estado
- versión publicada
- Descripción
- Multichannel Intraluminal Impedance and pH Monitoring (pHMII) is considered the "gold standard" for gastroesophageal reflux (GER) evaluation, but pediatric reference values are still controversial. In children with cerebral palsy (CP), gastroesophageal reflux disease (GERD) is a common complication, but diagnosis is challenging. Interpreting symptoms is challenging, and there is limited research on pHMII reference values in this group.Aim: To compare the features of pHMII tracings in children with CP and children with suspected GERD without CP, whose results were normal according to Mousa reference values.Materials and Methods: Multicenter, retrospective and analytical study. We evaluated tracings of children from 1 to 15 years old evaluated from May 2017 to January 2024 carried out by members of the LASPGHAN motility group work in centers of Latin America and Spain.Population n: 245; Group 1: n: 110(CP children), Group 2: n:135(children without CP)Children under 1 year of age, patients with esophageal atresia, or previous Nissen surgery, corrected or uncorrected diaphragmatic hernia, medical treatment with antacids or prokinetics during the study, and less than 18 hours studies were excluded.All patients underwent 24-hour pHMII under the same protocol.Prior to the study, proton pump inhibitors were suspended for at least 7 days, and prokinetics and H2 antagonists were suspended 48 hours before.Catheters of age-appropriate caliber were used, calibrated in buffers solutions pH 4 and pH 7 before placement. The catheter was inserted posteriorly and the tip was positioned in the second vertebral body above the diaphragm, using the Stroebbel formula to calculate the approximate length. Position was confirmed with x-ray. After connecting the catheter to the external impedance equipment, parents were given information about its use and they were given an event recording sheet to mark symptoms that they could not mark on the equipment. All tracings were automatically evaluated in BioVIEW software, and then analyzed manually.Exploratory analyses were performed using hierarchical clustering with Euclidean distance. Quantitative variables were described by their mean and standard deviation, and statistical significance was assessed using ANOVA and t-tests. Qualitative variables were described using contingency tables and assessed with the chi-square test. All analyses were conducted and visualized using the R statistical package. A p-value < 0.05 was considered significant.Results: 245 patients were included, of which 110 belonged to the CP group and the rest to the control group. The total number of reflux episodes by pHMII was lower in the CP group (p= 0.001488). Significant differences were observed in the 24-hour baseline and at night being in both cases lower in group 1 (p = 1,816e-07 and p = 7,497e-07) respectively.In children with CP, higher values were found in acid clearance time (p-value = 0.02247).Conclusion: Acid clearance is higher in children with CP with fewer reflux episodes than in the normal population. This could explain why esophageal damage can be found with fewer reflux episodes. We found baseline significant lower values in CP children, which could be due to associated motor disorders. Prospective studies including scope findings are necessary to establish reference values of pHMII in children with cerebral palsy. The use of a validated method like pHMII could be an important tool to avoid more invasive studies and have better monitoring of treatment.
Fil: Lorenzo, Cristina. Provincia de Buenos Aires. Ministerio de Salud. Hospital de Niños "Sor María Ludovica" de La Plata; Argentina
Fil: Zubiri, Cecilia. Provincia de Buenos Aires. Ministerio de Salud. Hospital de Niños "Sor María Ludovica" de La Plata; Argentina
Fil: Zosi, Anabella. Provincia de Buenos Aires. Ministerio de Salud. Hospital de Niños "Sor María Ludovica" de La Plata; Argentina
Fil: Miculan, Sandro. Provincia de Buenos Aires. Ministerio de Salud. Hospital de Niños "Sor María Ludovica" de La Plata; Argentina
Fil: Bigliardi, Roman. Hospital Nacional Profesor Alejandro Posadas; Argentina
Fil: Neder, Daniela. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina
Fil: Rocca, Ana. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina
Fil: Cohen Sabban, Judith. Hospital Italiano; Argentina
Fil: Manterola, Manuela. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; Argentina
Fil: Savia, Maria de Los Angeles. Hospital Cestino; Argentina
Fil: Mortarini, Maria. Universidad Austral. Hospital Universitario Austral; Argentina
Fil: Weinschelbaum, Renata. Hospital de Niños; Argentina
Fil: Saps, Miguel. University of Miami; Estados Unidos
Fil: Boggio, Christian. Gobierno de la Ciudad Autonoma de Buenos Aires. Hospital General de Agudos Doctor Ignacio Pirovano .; Argentina
Fil: Plante, Verónica. Gobierno de la Ciudad Autonoma de Buenos Aires. Hospital General de Agudos Doctor Ignacio Pirovano .; Argentina
Fil: Arcucci, Soledad. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; Argentina
Fil: Perez, Luis Orlando. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Centro Nacional Patagónico. Instituto Patagónico de Ciencias Sociales y Humanas; Argentina
Fil: Toro Mojaraz, Erick. Hospital Angeles Acoxpa; México
Fil: Ruiz Hernandez, Carlos. Hospital Sant Joan de Deu Barcelona; España
Fil: Tahan, Soraia. Universidade Federal de Sao Paulo; Brasil
Fil: Fontenele Soares, Ana Cristina. Universidade Federal de Sao Paulo; Brasil
Annual Meeting of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition
Hollywood, Florida
Estados Unidos
North American Society for Pediatric Gastroenterology, Hepatology and Nutrition - Materia
-
GASTROESOPHAGEAL REFLUX
IMPEDANCE MONITORING
PHMONITORING
CEREBRAL PALSY - Nivel de accesibilidad
- acceso abierto
- Condiciones de uso
- https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
- Repositorio
.jpg)
- Institución
- Consejo Nacional de Investigaciones Científicas y Técnicas
- OAI Identificador
- oai:ri.conicet.gov.ar:11336/265069
Ver los metadatos del registro completo
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Analysis of multichannel intraluminal impedance and phmonitoring values in children with cerebral palsy laspghan working group comparative multicenter studyLorenzo, CristinaZubiri, CeciliaZosi, AnabellaMiculan, SandroBigliardi, RomanNeder, DanielaRocca, AnaCohen Sabban, JudithManterola, ManuelaSavia, Maria de Los AngelesMortarini, MariaWeinschelbaum, RenataSaps, MiguelBoggio, ChristianPlante, VerónicaArcucci, SoledadPerez, Luis OrlandoToro Mojaraz, ErickRuiz Hernandez, CarlosTahan, SoraiaFontenele Soares, Ana CristinaGASTROESOPHAGEAL REFLUXIMPEDANCE MONITORINGPHMONITORINGCEREBRAL PALSYhttps://purl.org/becyt/ford/3.3https://purl.org/becyt/ford/3Multichannel Intraluminal Impedance and pH Monitoring (pHMII) is considered the "gold standard" for gastroesophageal reflux (GER) evaluation, but pediatric reference values are still controversial. In children with cerebral palsy (CP), gastroesophageal reflux disease (GERD) is a common complication, but diagnosis is challenging. Interpreting symptoms is challenging, and there is limited research on pHMII reference values in this group.Aim: To compare the features of pHMII tracings in children with CP and children with suspected GERD without CP, whose results were normal according to Mousa reference values.Materials and Methods: Multicenter, retrospective and analytical study. We evaluated tracings of children from 1 to 15 years old evaluated from May 2017 to January 2024 carried out by members of the LASPGHAN motility group work in centers of Latin America and Spain.Population n: 245; Group 1: n: 110(CP children), Group 2: n:135(children without CP)Children under 1 year of age, patients with esophageal atresia, or previous Nissen surgery, corrected or uncorrected diaphragmatic hernia, medical treatment with antacids or prokinetics during the study, and less than 18 hours studies were excluded.All patients underwent 24-hour pHMII under the same protocol.Prior to the study, proton pump inhibitors were suspended for at least 7 days, and prokinetics and H2 antagonists were suspended 48 hours before.Catheters of age-appropriate caliber were used, calibrated in buffers solutions pH 4 and pH 7 before placement. The catheter was inserted posteriorly and the tip was positioned in the second vertebral body above the diaphragm, using the Stroebbel formula to calculate the approximate length. Position was confirmed with x-ray. After connecting the catheter to the external impedance equipment, parents were given information about its use and they were given an event recording sheet to mark symptoms that they could not mark on the equipment. All tracings were automatically evaluated in BioVIEW software, and then analyzed manually.Exploratory analyses were performed using hierarchical clustering with Euclidean distance. Quantitative variables were described by their mean and standard deviation, and statistical significance was assessed using ANOVA and t-tests. Qualitative variables were described using contingency tables and assessed with the chi-square test. All analyses were conducted and visualized using the R statistical package. A p-value < 0.05 was considered significant.Results: 245 patients were included, of which 110 belonged to the CP group and the rest to the control group. The total number of reflux episodes by pHMII was lower in the CP group (p= 0.001488). Significant differences were observed in the 24-hour baseline and at night being in both cases lower in group 1 (p = 1,816e-07 and p = 7,497e-07) respectively.In children with CP, higher values were found in acid clearance time (p-value = 0.02247).Conclusion: Acid clearance is higher in children with CP with fewer reflux episodes than in the normal population. This could explain why esophageal damage can be found with fewer reflux episodes. We found baseline significant lower values in CP children, which could be due to associated motor disorders. Prospective studies including scope findings are necessary to establish reference values of pHMII in children with cerebral palsy. The use of a validated method like pHMII could be an important tool to avoid more invasive studies and have better monitoring of treatment.Fil: Lorenzo, Cristina. Provincia de Buenos Aires. Ministerio de Salud. Hospital de Niños "Sor María Ludovica" de La Plata; ArgentinaFil: Zubiri, Cecilia. Provincia de Buenos Aires. Ministerio de Salud. Hospital de Niños "Sor María Ludovica" de La Plata; ArgentinaFil: Zosi, Anabella. Provincia de Buenos Aires. Ministerio de Salud. Hospital de Niños "Sor María Ludovica" de La Plata; ArgentinaFil: Miculan, Sandro. Provincia de Buenos Aires. Ministerio de Salud. Hospital de Niños "Sor María Ludovica" de La Plata; ArgentinaFil: Bigliardi, Roman. Hospital Nacional Profesor Alejandro Posadas; ArgentinaFil: Neder, Daniela. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Rocca, Ana. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Cohen Sabban, Judith. Hospital Italiano; ArgentinaFil: Manterola, Manuela. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; ArgentinaFil: Savia, Maria de Los Angeles. Hospital Cestino; ArgentinaFil: Mortarini, Maria. Universidad Austral. Hospital Universitario Austral; ArgentinaFil: Weinschelbaum, Renata. Hospital de Niños; ArgentinaFil: Saps, Miguel. University of Miami; Estados UnidosFil: Boggio, Christian. Gobierno de la Ciudad Autonoma de Buenos Aires. Hospital General de Agudos Doctor Ignacio Pirovano .; ArgentinaFil: Plante, Verónica. Gobierno de la Ciudad Autonoma de Buenos Aires. Hospital General de Agudos Doctor Ignacio Pirovano .; ArgentinaFil: Arcucci, Soledad. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Perez, Luis Orlando. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Centro Nacional Patagónico. Instituto Patagónico de Ciencias Sociales y Humanas; ArgentinaFil: Toro Mojaraz, Erick. Hospital Angeles Acoxpa; MéxicoFil: Ruiz Hernandez, Carlos. Hospital Sant Joan de Deu Barcelona; EspañaFil: Tahan, Soraia. Universidade Federal de Sao Paulo; BrasilFil: Fontenele Soares, Ana Cristina. Universidade Federal de Sao Paulo; BrasilAnnual Meeting of the North American Society for Pediatric Gastroenterology, Hepatology and NutritionHollywood, FloridaEstados UnidosNorth American Society for Pediatric Gastroenterology, Hepatology and NutritionWiley2024info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/conferenceObjectReuniónJournalhttp://purl.org/coar/resource_type/c_5794info:ar-repo/semantics/documentoDeConferenciaapplication/pdfapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/265069Analysis of multichannel intraluminal impedance and phmonitoring values in children with cerebral palsy laspghan working group comparative multicenter study; Annual Meeting of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition; Hollywood, Florida; Estados Unidos; 2024; S506-S5072691-171XCONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/doi/10.1002/jpr3.12132info:eu-repo/semantics/altIdentifier/url/https://onlinelibrary.wiley.com/doi/10.1002/jpr3.12132Internacionalinfo:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by-nc-sa/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2025-09-03T09:56:34Zoai:ri.conicet.gov.ar:11336/265069instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982025-09-03 09:56:34.31CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse |
| dc.title.none.fl_str_mv |
Analysis of multichannel intraluminal impedance and phmonitoring values in children with cerebral palsy laspghan working group comparative multicenter study |
| title |
Analysis of multichannel intraluminal impedance and phmonitoring values in children with cerebral palsy laspghan working group comparative multicenter study |
| spellingShingle |
Analysis of multichannel intraluminal impedance and phmonitoring values in children with cerebral palsy laspghan working group comparative multicenter study Lorenzo, Cristina GASTROESOPHAGEAL REFLUX IMPEDANCE MONITORING PHMONITORING CEREBRAL PALSY |
| title_short |
Analysis of multichannel intraluminal impedance and phmonitoring values in children with cerebral palsy laspghan working group comparative multicenter study |
| title_full |
Analysis of multichannel intraluminal impedance and phmonitoring values in children with cerebral palsy laspghan working group comparative multicenter study |
| title_fullStr |
Analysis of multichannel intraluminal impedance and phmonitoring values in children with cerebral palsy laspghan working group comparative multicenter study |
| title_full_unstemmed |
Analysis of multichannel intraluminal impedance and phmonitoring values in children with cerebral palsy laspghan working group comparative multicenter study |
| title_sort |
Analysis of multichannel intraluminal impedance and phmonitoring values in children with cerebral palsy laspghan working group comparative multicenter study |
| dc.creator.none.fl_str_mv |
Lorenzo, Cristina Zubiri, Cecilia Zosi, Anabella Miculan, Sandro Bigliardi, Roman Neder, Daniela Rocca, Ana Cohen Sabban, Judith Manterola, Manuela Savia, Maria de Los Angeles Mortarini, Maria Weinschelbaum, Renata Saps, Miguel Boggio, Christian Plante, Verónica Arcucci, Soledad Perez, Luis Orlando Toro Mojaraz, Erick Ruiz Hernandez, Carlos Tahan, Soraia Fontenele Soares, Ana Cristina |
| author |
Lorenzo, Cristina |
| author_facet |
Lorenzo, Cristina Zubiri, Cecilia Zosi, Anabella Miculan, Sandro Bigliardi, Roman Neder, Daniela Rocca, Ana Cohen Sabban, Judith Manterola, Manuela Savia, Maria de Los Angeles Mortarini, Maria Weinschelbaum, Renata Saps, Miguel Boggio, Christian Plante, Verónica Arcucci, Soledad Perez, Luis Orlando Toro Mojaraz, Erick Ruiz Hernandez, Carlos Tahan, Soraia Fontenele Soares, Ana Cristina |
| author_role |
author |
| author2 |
Zubiri, Cecilia Zosi, Anabella Miculan, Sandro Bigliardi, Roman Neder, Daniela Rocca, Ana Cohen Sabban, Judith Manterola, Manuela Savia, Maria de Los Angeles Mortarini, Maria Weinschelbaum, Renata Saps, Miguel Boggio, Christian Plante, Verónica Arcucci, Soledad Perez, Luis Orlando Toro Mojaraz, Erick Ruiz Hernandez, Carlos Tahan, Soraia Fontenele Soares, Ana Cristina |
| author2_role |
author author author author author author author author author author author author author author author author author author author author |
| dc.subject.none.fl_str_mv |
GASTROESOPHAGEAL REFLUX IMPEDANCE MONITORING PHMONITORING CEREBRAL PALSY |
| topic |
GASTROESOPHAGEAL REFLUX IMPEDANCE MONITORING PHMONITORING CEREBRAL PALSY |
| purl_subject.fl_str_mv |
https://purl.org/becyt/ford/3.3 https://purl.org/becyt/ford/3 |
| dc.description.none.fl_txt_mv |
Multichannel Intraluminal Impedance and pH Monitoring (pHMII) is considered the "gold standard" for gastroesophageal reflux (GER) evaluation, but pediatric reference values are still controversial. In children with cerebral palsy (CP), gastroesophageal reflux disease (GERD) is a common complication, but diagnosis is challenging. Interpreting symptoms is challenging, and there is limited research on pHMII reference values in this group.Aim: To compare the features of pHMII tracings in children with CP and children with suspected GERD without CP, whose results were normal according to Mousa reference values.Materials and Methods: Multicenter, retrospective and analytical study. We evaluated tracings of children from 1 to 15 years old evaluated from May 2017 to January 2024 carried out by members of the LASPGHAN motility group work in centers of Latin America and Spain.Population n: 245; Group 1: n: 110(CP children), Group 2: n:135(children without CP)Children under 1 year of age, patients with esophageal atresia, or previous Nissen surgery, corrected or uncorrected diaphragmatic hernia, medical treatment with antacids or prokinetics during the study, and less than 18 hours studies were excluded.All patients underwent 24-hour pHMII under the same protocol.Prior to the study, proton pump inhibitors were suspended for at least 7 days, and prokinetics and H2 antagonists were suspended 48 hours before.Catheters of age-appropriate caliber were used, calibrated in buffers solutions pH 4 and pH 7 before placement. The catheter was inserted posteriorly and the tip was positioned in the second vertebral body above the diaphragm, using the Stroebbel formula to calculate the approximate length. Position was confirmed with x-ray. After connecting the catheter to the external impedance equipment, parents were given information about its use and they were given an event recording sheet to mark symptoms that they could not mark on the equipment. All tracings were automatically evaluated in BioVIEW software, and then analyzed manually.Exploratory analyses were performed using hierarchical clustering with Euclidean distance. Quantitative variables were described by their mean and standard deviation, and statistical significance was assessed using ANOVA and t-tests. Qualitative variables were described using contingency tables and assessed with the chi-square test. All analyses were conducted and visualized using the R statistical package. A p-value < 0.05 was considered significant.Results: 245 patients were included, of which 110 belonged to the CP group and the rest to the control group. The total number of reflux episodes by pHMII was lower in the CP group (p= 0.001488). Significant differences were observed in the 24-hour baseline and at night being in both cases lower in group 1 (p = 1,816e-07 and p = 7,497e-07) respectively.In children with CP, higher values were found in acid clearance time (p-value = 0.02247).Conclusion: Acid clearance is higher in children with CP with fewer reflux episodes than in the normal population. This could explain why esophageal damage can be found with fewer reflux episodes. We found baseline significant lower values in CP children, which could be due to associated motor disorders. Prospective studies including scope findings are necessary to establish reference values of pHMII in children with cerebral palsy. The use of a validated method like pHMII could be an important tool to avoid more invasive studies and have better monitoring of treatment. Fil: Lorenzo, Cristina. Provincia de Buenos Aires. Ministerio de Salud. Hospital de Niños "Sor María Ludovica" de La Plata; Argentina Fil: Zubiri, Cecilia. Provincia de Buenos Aires. Ministerio de Salud. Hospital de Niños "Sor María Ludovica" de La Plata; Argentina Fil: Zosi, Anabella. Provincia de Buenos Aires. Ministerio de Salud. Hospital de Niños "Sor María Ludovica" de La Plata; Argentina Fil: Miculan, Sandro. Provincia de Buenos Aires. Ministerio de Salud. Hospital de Niños "Sor María Ludovica" de La Plata; Argentina Fil: Bigliardi, Roman. Hospital Nacional Profesor Alejandro Posadas; Argentina Fil: Neder, Daniela. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina Fil: Rocca, Ana. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina Fil: Cohen Sabban, Judith. Hospital Italiano; Argentina Fil: Manterola, Manuela. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; Argentina Fil: Savia, Maria de Los Angeles. Hospital Cestino; Argentina Fil: Mortarini, Maria. Universidad Austral. Hospital Universitario Austral; Argentina Fil: Weinschelbaum, Renata. Hospital de Niños; Argentina Fil: Saps, Miguel. University of Miami; Estados Unidos Fil: Boggio, Christian. Gobierno de la Ciudad Autonoma de Buenos Aires. Hospital General de Agudos Doctor Ignacio Pirovano .; Argentina Fil: Plante, Verónica. Gobierno de la Ciudad Autonoma de Buenos Aires. Hospital General de Agudos Doctor Ignacio Pirovano .; Argentina Fil: Arcucci, Soledad. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; Argentina Fil: Perez, Luis Orlando. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Centro Nacional Patagónico. Instituto Patagónico de Ciencias Sociales y Humanas; Argentina Fil: Toro Mojaraz, Erick. Hospital Angeles Acoxpa; México Fil: Ruiz Hernandez, Carlos. Hospital Sant Joan de Deu Barcelona; España Fil: Tahan, Soraia. Universidade Federal de Sao Paulo; Brasil Fil: Fontenele Soares, Ana Cristina. Universidade Federal de Sao Paulo; Brasil Annual Meeting of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Hollywood, Florida Estados Unidos North American Society for Pediatric Gastroenterology, Hepatology and Nutrition |
| description |
Multichannel Intraluminal Impedance and pH Monitoring (pHMII) is considered the "gold standard" for gastroesophageal reflux (GER) evaluation, but pediatric reference values are still controversial. In children with cerebral palsy (CP), gastroesophageal reflux disease (GERD) is a common complication, but diagnosis is challenging. Interpreting symptoms is challenging, and there is limited research on pHMII reference values in this group.Aim: To compare the features of pHMII tracings in children with CP and children with suspected GERD without CP, whose results were normal according to Mousa reference values.Materials and Methods: Multicenter, retrospective and analytical study. We evaluated tracings of children from 1 to 15 years old evaluated from May 2017 to January 2024 carried out by members of the LASPGHAN motility group work in centers of Latin America and Spain.Population n: 245; Group 1: n: 110(CP children), Group 2: n:135(children without CP)Children under 1 year of age, patients with esophageal atresia, or previous Nissen surgery, corrected or uncorrected diaphragmatic hernia, medical treatment with antacids or prokinetics during the study, and less than 18 hours studies were excluded.All patients underwent 24-hour pHMII under the same protocol.Prior to the study, proton pump inhibitors were suspended for at least 7 days, and prokinetics and H2 antagonists were suspended 48 hours before.Catheters of age-appropriate caliber were used, calibrated in buffers solutions pH 4 and pH 7 before placement. The catheter was inserted posteriorly and the tip was positioned in the second vertebral body above the diaphragm, using the Stroebbel formula to calculate the approximate length. Position was confirmed with x-ray. After connecting the catheter to the external impedance equipment, parents were given information about its use and they were given an event recording sheet to mark symptoms that they could not mark on the equipment. All tracings were automatically evaluated in BioVIEW software, and then analyzed manually.Exploratory analyses were performed using hierarchical clustering with Euclidean distance. Quantitative variables were described by their mean and standard deviation, and statistical significance was assessed using ANOVA and t-tests. Qualitative variables were described using contingency tables and assessed with the chi-square test. All analyses were conducted and visualized using the R statistical package. A p-value < 0.05 was considered significant.Results: 245 patients were included, of which 110 belonged to the CP group and the rest to the control group. The total number of reflux episodes by pHMII was lower in the CP group (p= 0.001488). Significant differences were observed in the 24-hour baseline and at night being in both cases lower in group 1 (p = 1,816e-07 and p = 7,497e-07) respectively.In children with CP, higher values were found in acid clearance time (p-value = 0.02247).Conclusion: Acid clearance is higher in children with CP with fewer reflux episodes than in the normal population. This could explain why esophageal damage can be found with fewer reflux episodes. We found baseline significant lower values in CP children, which could be due to associated motor disorders. Prospective studies including scope findings are necessary to establish reference values of pHMII in children with cerebral palsy. The use of a validated method like pHMII could be an important tool to avoid more invasive studies and have better monitoring of treatment. |
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2024 |
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Analysis of multichannel intraluminal impedance and phmonitoring values in children with cerebral palsy laspghan working group comparative multicenter study; Annual Meeting of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition; Hollywood, Florida; Estados Unidos; 2024; S506-S507 2691-171X CONICET Digital CONICET |
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