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Aim: To review data from clinical studies on a multichannel intraluminal impedance-pH measurement in children with gastroesophageal reflux disease (GERD). Key points: Esophageal pH measurement is considered a golden standard of GERD diagnostics   in  children.  However,  this  method can identify only the  acid reflux. Recently, multichannel  intraluminal impedance measurement of esophagus has been  introduced into the work-up of such children. This method gives the opportunity to diagnose  liquid, gas or mixed types of reflux and to determine whether it is acid, weakly acid or basic, as well as to obtain  data  on localization of the bolus in the esophagus, its length  and direction of movement (antegrade or retrograde). We present  the information on normal parameters of multichannel  intraluminal impedance and its use for assessment of infants,  as well as on changes in its parameters in children  with apnoe  and  on clinical value of non-acid reflux. The significance of multichannel intraluminal impedance in detection of esophageal disorders in patients  with otolaryngologic  symptoms   and  other  extra-esophageal signs  is discussed. Аn association  between the results  of this method and  endoscopic  and  histological abnormalities  found in GERD patients  is being actively studied. The authors  of the review focus their attention on the  data  on changes  of multichannel  intraluminal impedance parameters during  treatment of GERD  children  with  proton pump  inhibitors. Conclusion: Multichannel intraluminal impedance is a new modern  method with wide spectrum of diagnostic opportunities.

About the authors

S. I. Erdes

I.M. Sechenov First Moscow State Medical University, Moscow

Author for correspondence.
Erdes Svetlana I. – MD, PhD, Professor, Head of the Chair of Pediatric Propedeutics, Pediatric Faculty Russian Federation

A. R. Polishchuk

I.M. Sechenov First Moscow State Medical University, Moscow

Polishchuk Albina R. – Assistant, Chair of Pediatric Propedeutics, Pediatric Faculty Russian Federation

I. A. Topolskova

I.M. Sechenov First Moscow State Medical University, Moscow

Topolskova Irina A. – Assistant, Chair of Pediatric Propedeutics, Pediatric Faculty Russian Federation


  1. Ивашкин ВТ, Маев ИВ, Трухманов АС. Пищевод Барретта. Т. 1. Гл. 6. Клинические проявления и методы диагностики пищевода Барретта. Импедансометрия. М.: Шико; 2011. с. 447–9.
  2. Маев ИВ, Вьючнова ЕС, Щекина МИ. Гастроэзофагеальная рефлюксная болезнь – болезнь XXI века. Лечащий врач. 2004;(4):10–4.
  3. Silny J. Intraluminal multiple electric impedance procedure for measurement of gastrointestinal motility. J Gastrointest Motil. 1991;3:151–62.
  4. Shay S. Esophageal impedance monitoring: the ups and downs of a new test. Am J Gastroenterol. 2004;99(6):1020–2.
  5. Peter CS, Wiechers C, Bohnhorst B, Silny J, Poets CF. Detection of small bolus volumes using multiple intraluminal impedance in preterm infants. J Pediatr Gastroenterol Nutr. 2003;36(3):381–4.
  6. Vandenplas Y, Rudolph CD, Di Lorenzo C, Hassall E, Liptak G, Mazur L, Sondheimer J, Staiano A, Thomson M, Veereman-Wauters G, Wenzl TG; North American Society for Pediatric Gastroenterology Hepatology and Nutrition, European Society for Pediatric Gastroenterology Hepatology and Nutrition. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2009;49(4):498–547. doi: 10.1097/MPG.0b013e3181b7f563.
  7. DeVault KR, Castell DO; American College of Gastroenterology. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol. 2005;100(1):190–200. doi: 10.1111/j.15720241.2005.41217.x.
  8. Bredenoord AJ, Weusten BL, Timmer R, Smout AJ. Characteristics of gastroesophageal reflux in symptomatic patients with and without excessive esophageal acid exposure. Am J Gastroenterol. 2006;101(11):2470–5.
  9. Vandenplas Y. Challenges in the diagnosis of gastroesophageal reflux disease in infants and children. Expert Opin Med Diagn. 2013;7(3):289–98. doi: 10.1517/17530059.2013.789857.
  10. Hyman PE, Milla PJ, Benninga MA, Davidson GP, Fleisher DF, Taminiau J. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology. 2006;130(5):1519–26.
  11. Sherman PM, Hassall E, Fagundes-Neto U, Gold BD, Kato S, Koletzko S, Orenstein S, Rudolph C, Vakil N, Vandenplas Y. A global, evidence-based consensus on the definition of gastroesophageal reflux disease in the pediatric population. Am J Gastroenterol. 2009;104(5):1278–95. doi: 10.1038/ ajg.2009.129.
  12. Pilic D, Fröhlich T, Nöh F, Pappas A, Schmidt-Choudhury A, Köhler H, Skopnik H, Wenzl TG. Detection of gastroesophageal reflux in children using combined multichannel intraluminal impedance and pH measurement: data from the German Pediatric Impedance Group. J Pediatr. 2011;158(4):650–654.e1. doi: 10.1016/j.jpeds.2010.09.033.
  13. López-Alonso M, Moya MJ, Cabo JA, Ribas J, del Carmen Macías M, Silny J, Sifrim D. Twenty-four-hour esophageal impedance-pH monitoring in healthy preterm neonates: rate and characteristics of acid, weakly acidic, and weakly alkaline gastroesophageal reflux. Pediatrics. 2006;118(2):e299–308.
  14. Wenzl TG, Schneider S, Scheele F, Silny J, Heimann G, Skopnik H. Effects of thickened feeding on gastroesophageal reflux in infants: a placebo-controlled crossover study using intraluminal impedance. Pediatrics. 2003;111(4 Pt 1):e355–9.
  15. Mousa H, Woodley FW, Metheney M, Hayes J. Testing the association between gastroesophageal reflux and apnea in infants. J Pediatr Gastroenterol Nutr. 2005;41(2):169–77.
  16. Magistà AM, Indrio F, Baldassarre M, Bucci N, Menolascina A, Mautone A, Francavilla R. Multichannel intraluminal impedance to detect relationship between gastroesophageal reflux and apnoea of prematurity. Dig Liver Dis. 2007;39(3):216–21.
  17. Lee SH, Jang JY, Yoon IJ, Kim KM. Usefulness of multichannel intraluminal impedance-pH metry in children with suspected gastroesophageal reflux disease. Korean J Gastroenterol. 2008;52(1):9–15.
  18. Shin MS, Shim JO, Moon JS, Kim HS, Ko JS, Choi JH, Seo JK. Impedance-pH monitoring and conventional pH monitoring are complementary methods to detect association between gastroesophageal reflux and apnea-related symptoms in preterm infants and neonates. J Matern Fetal Neonatal Med. 2012;25(11):2406–10. doi: 10.3109/14767058.2012.697944.
  19. Wenzl TG, Schenke S, Peschgens T, Silny J, Heimann G, Skopnik H. Association of apnea and nonacid gastroesophageal reflux in infants: Investigations with the intraluminal impedance technique. Pediatr Pulmonol. 2001;31(2): 144–9.
  20. Rosen R, Nurko S. The importance of multichannel intraluminal impedance in the evaluation of children with persistent respiratory symptoms. Am J Gastroenterol. 2004;99(12): 2452–8.
  21. Loots CM, Benninga MA, Davidson GP, Omari TI. Addition of pH-impedance monitoring to standard pH monitoring increases the yield of symptom association analysis in infants and children with gastroesophageal reflux. J Pediatr. 2009;154(2):248–52. doi: 10.1016/j. jpeds.2008.08.019.
  22. Cudejko RJ, Dziekiewicz M, Banaszkiewicz A, Skarzynski H, Radzikowski A. Persistent upper respiratory diseases in children: role of gastroesophageal reflux studied using intraluminal impedance and pH. JHS. 2012;2(1):OA41–5. doi: 10.17430/882713.
  23. Salvatore S, Hauser B, Devreker T, Arrigo S, Marino P, Citro C, Salvatoni A, Vandenplas Y. Esophageal impedance and esophagitis in children: any correlation? J Pediatr Gastroenterol Nutr. 2009;49(5):566–70. doi: 10.1097/ MPG.0b013e3181a23dac.
  24. Salvatore S, Salvatoni A, Ummarino D, Ghanma A, VanderPol R, Rongen A, Fuoti M, Meneghin F, Benninga MA, Vandenplas Y. Low mean impedance in 24-hour tracings and esophagitis in children: a strong connection. Dis Esophagus. 2014. doi: 10.1111/dote.12290. [Epub ahead of print]
  25. Salvatore S, Salvatoni A, VanSteen K, Ummarino D, Hauser B, Vandenplas Y. Behind the (impedance) baseline in children. Dis Esophagus. 2014;27(8):726–31. doi: 10.1111/dote.12152.
  26. Pilic D, Hankel S, Koerner-Rettberg C, Hamelmann E, Schmidt-Choudhury A. The role of baseline impedance as a marker of mucosal integrity in children with gastro esophageal reflux disease. Scand J Gastroenterol. 2013;48(7):785–93. doi: 10.3109/00365521.2013.793388.
  27. Ummarino D, Salvatore S, Hauser B, Staiano A, Vandenplas Y. Esophageal impedance baseline according to different time intervals. Eur J Med Res. 2012;17:18. doi: 10.1186/2047-783X-17-18.
  28. Dalby K, Nielsen RG, Kruse-Andersen S, Fenger C, Durup J, Husby S. Gastroesophageal reflux disease and eosinophilic esophagitis in infants and children. A study of esophageal pH, multiple intraluminal impedance and endoscopic ultrasound. Scand J Gastroenterol. 2010;45(9):1029–35. doi: 10.3109/00365521.2010.487917.
  29. Mainie I, Tutuian R, Shay S, Vela M, Zhang X, Sifrim D, Castell DO. Acid and non-acid reflux in patients with persistent symptoms despite acid suppressive therapy: a multicentre study using combined ambulatory impedance-pH monitoring. Gut. 2006;55(10):1398–402.
  30. Loots CM, Van Wijk MP, Smits MJ, Wenzl TG, Benninga MA, Omari TI. Measurement of mucosal conductivity by MII is a potential marker of mucosal integrity restored in infants on acid-suppression therapy. J Pediatr Gastroenterol Nutr. 2011;53(1):120–3. doi: 10.1097/MPG. 0b013e318214c3cc.

Copyright (c) 2015 Erdes S.I., Polishchuk A.R., Topolskova I.A.

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