Twenty-four hour exophageal pH monitoring in gastroesophageal reflux.

Twenty-four hour pH esophageal monitoring has been studied in 123 children with gastroesophageal reflux (GER) with ages ranging between 6 mo to 6 yr. The technique is described and the scoring system modified to evaluate gastroesophageal reflux in these patients. For the first time the normal patterns are presented in pediatrics (n = 20). The results obtained in 103 patients are presented, divided into pre- and post-nonoperative and surgically treated groups. The test is more objective, has greater precision, sensitivity, and reliability than contrast studies, endoscopy, acid perfusion or acid reflux tests. The study seems to indicate that esophagitis depends more on the duration of the reflux than on the number, for which the concept of esophageal acid clearance is of paramount importance. The prone position generally lessens the number of refluxes but in this position the esophageal acid clearance is altered. With a greater knowledge and more experience in this technique, we would be able to identify children at risk to develop severe complications, control them and aid in the selection of those patients requiring surgical intervention.