The child with chronic cough: when does double-channel pH monitoring rule out gastroesophageal reflux

Background: gastroesophageal reflux (GER) plays a major role in the pathogenesis of pediatric chronic airway disease. Esophageal pH-monitoring (epHM) is the diagnostic gold standard for acid GER. To date, there are no cut-off values for chronically coughing children ruling out relevant GER. Methods: 24-hour, double-channel epHM was performed in 549 children (3 months to 16 years old) with chronic pulmonary disease. We stratified according to age as follows: ≤ 1.5 years, > 1.5 - 4 years, > 4 - 8 years, > 8 12 - 16 years. Following parameters were calculated for both channels: total number of reflux episodes, number of reflux episodes > 5 minutes, duration of the longest reflux episode, and reflux index. Results: according to the above given age classification, the median number of reflux episodes in the lower esophagus was 31, 27, 32, 34, and 42 and for the upper esophagus 20, 13, 15, 14, and 11 respectively. The median reflux index at the distal esophagus was 2.55, 2.1, 2.3, 2.15, and 1.9; at the upper esophagus it was 1.4, 1.0, 1.1, 0.9, and 0.6 respectively. Conclusions: our data contribute useful support to the evaluation of pediatric airway disease. We provide reference values for decisions in the exploration of children with airway disorders and suspected GER.