A Unique Teletransmission System for Extended Four-Channel Esophageal pH Monitoring in Infants and Children

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A new computerized telemetry system for extended esophageal pH monitoring is prospectively evaluated and compared with other diagnostic modalities in 38 pediatric patients suspected of having gastroesophageal reflux (GER). Unique circuitry allows connection of 1.5 mm diameter antimony electrodes to a patient-worn digital recorder that continuously samples pH at four levels from pharynx to distal esophagus. Ambulatory studies in a “physiologic” environment are possible and data is teletransmitted by the satellite computer to the central laboratory for analysis. Of 41 studies completed, four were lost to interpretation because of battery, electrode, or computer failure. Thirty-seven studies could be analyzed in five clinical groups: emesis and failure to thrive; status post esophageal atresia repair; apnea/bradycardia; central nervous system damage; and status post antireflux procedure. Pathologic GER was noted 14 times and an antireflux procedure was clinically required in 13 instances. In five cases the upper GI series failed to detect the GER. Twenty-three studies showed no GER, and the clinical symptoms resolved with appropriate medical therapy in 21 cases. The upper GI series demonstrated GER five times in this group. In the nine instances that esophagoscopy/biopsy was employed, the pH study findings were uniformly confirmed. This computerized system provided a technically complete and interpretable study 90% of the time. Based on patient outcome, the extended pH monitoring was 92% accurate in detecting clinically important GER with a sensitivity of 87% and specificity of 93%. The upper GI series demonstrated a 69% accuracy with a 60% sensitivity and 64% specificity (P=.01). Potential advantages of this new technology are (1) ambulatory studies allowing normal activity schedule in physiologic environment; (2) outpatient capability, which is cost effective compared with in-hospital monitoring; (3) four-channel recording to evaluate middle and upper esophageal pH for apnea or pulmonary symptoms; and (4) satellite computer transmission capacity for performing the study in any setting (ie, physician's office) and analyzing data uniformly by central laboratory.



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