Prevalence of gastroesophageal reflux disease in children with extraesophageal manifestations using combined-video, multichannel intraluminal impedance-pH study

Table 1 Demographic characteristics and parameters from Multichannel intraluminal impedance-pH study in children diagnosed with extraesophageal gastroesophageal reflux disease and no extraesophageal gastroesophageal reflux disease, n, (%)

Characteristics	No extraesophageal GERD (n = 33)	Diagnosed extraesophageal GERD by MII-pH study (n = 18)	P value
			Univariable analysis	Multivariable analysis
Age (yr) (median, IQR)	1.67 (0.91, 3.38)	4.58 (1.70, 13.15)	0.174
Age < 1 yr	10 (30.3)	2 (11.1)
Age ≥ 1 yr	23 (69.7)	16 (88.9)
Sex, male	17 (51.5)	10 (55.6)	1
Underlying diseases			0.441
Respiratory disorder
Bronchiectasis	1 (3.03)	0
Chronic lung disease	7 (21.21)	2 (11.11)
Congenital hypoventilation syndrome	0	2 (11.11)
Subglottic stenosis	0	1 (5.56)
Tracheobronchomalacia	1 (3.03)	0
Laryngomalacia	1 (3.03)	0
BRUE	1 (3.03)	0
Chronic cough	1 (3.03)	0
Neurological disorder
Swallowing dysfunction	2 (6.06)	1 (5.56)
Spastic cerebral palsy	2 (6.06)	3 (16.67)
Infantile spasm	1 (3.03)	0
Multiple anomalies
Syndromic disorder	6 (18.18)	2 (11.11)
Non-syndromic disorder	9 (27.27)	7 (38.89)
Indication for evaluation
Extraesophageal symptoms			0.679
Recurrent pneumonia	9 (27.3)	4 (22.2)
Hypersecretion	4 (12.1)	2 (11.1)
Cough	11 (33.3)	10 (55.6)
Glossoptosis	1 (3.0)	0
Tracheobronchomalacia	1 (3.0)	0
Stridor	1 (3.0)	0
Choking	4 (12.1)	1 (5.6)
Chronic rhinosinusitis	0	1 (5.6)
BRUEs	1 (3.0)	0
Apnea	1 (3.0)	0
Esophageal symptoms			0.293
Vomiting	8 (24.2)	6 (38.9)
Heartburn	1 (3.0)	1 (5.6)
None	24 (72.7)	11 (61.1)
Total recorded symptoms (times, %)	94	171	0.033	0.064
Cough	43 (45.75)	66 (38.60)	0.404
Irritability	32 (34.04)	22 (12.86)	0.754
Apparent secretion	7 (7.44)	17 (9.94)	0.346
GI symptoms (vomiting or heartburn)	12 (12.77)	66 (38.60)	0.081
Impedance parameters (median, IQR)
Total time (hours)	22.12 (20.34, 24.04)	21.34 (19.97, 22.62)	0.391
Reflux index1	0.40 (0, 1.45)	8.4 (4.43, 14.20)	0.001
Longest reflux time (min)	1.3 (0, 4.30)	17.2 (9.43, 38.55)	0.001
Total reflux events1	12 (5.00, 37.50)	28 (18.50, 45.50)	0.032	0.012
Weakly acid reflux events
Acid reflux events	9 (2.50, 27.00)	10 (3.75, 21.75)	0.79
Nonacid reflux events	1 (0, 4.50)	15.5 (8.75, 25.25)	0.001
Symptom indices	0 (0, 4.00)	0 (0,1.00)	0.381	0.212
Symptom index1	0 (0, 0.00)	0 (0, 12.73)	0.208
Symptom sensitivity index1	0 (0, 0.00)	0 (0, 1.40)	0.32
Symptom associated index1	0 (0, 0.00)	0 (0, 85.63)	0.168
MNBI (ohms) (mean, SD)	1897.69 (806.89)	1300.48 (600.31)	0.008
PSPW (%) (mean, SD)	53.57 (27.59)	56.11 (15.70)	0.721
Diagnosis GERD
Gross finding (n = 25)	8/12 (66.7)	10/13 (76.9)	0.673
Histopathology (n = 22)	6/11 (54.5)	10/11 (90.9)	0.149

¹Significant factors in univariable analysis were not included in the multivariable analysis because of collinearity with criteria diagnosis gastroesophageal reflux disease using the MII-pH study.

BRUE: Brief resolved unexplained event; MNBI: Mean nocturnal baseline impedance; PSPW: Post-reflux swallow-induced peristaltic wave index; GERD: Gastroesophageal reflux disease; MII-pH: Multichannel intraluminal impedance-pH; IQR: Interquartile range.

Table 2 Comparing symptoms recorded by conventional and combined visual data object -monitoring in children who underwent multichannel intraluminal impedance-pH study (n = 17), n, (%)

Characteristics	Conventional MII-pH study	Combined video-MII-pH study	P value
Total recorded symptoms	120	220	0.062
Cough	31 (25.83)	46 (20.90)	0.259
Irritability	38 (31.67)	101 (45.90)	0.114
Apparent secretion	3 (2.50)	43 (19.55)	0.02
GI symptoms (vomiting or heartburn)	48 (40.00)	33 (15.00)	0.339
Symptom indices (median, IQR)
Symptom index	0 (0–5.00)	0 (0–11.65)	0.306
Symptom sensitivity index	0 (0–2.65)	0 (0–5.80)	0.306
Symptom associated index	0 (0–37.60)	0 (0–93.15)	0.306
Diagnosis GERD using symptom indices	2 (11.76)	5 (29.41)	0.398

GI: Gastrointestinal; GERD: Gastroesophageal reflux disease; MII-pH: Multichannel intraluminal impedance-pH; IQR Interquartile range.