DOI: 10.1097/MPG.0b013e318214c6ef

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Issn Print: 0277-2116

Publication Date: 2011/06/01


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“Evaluation of Esophageal Motility Using Multichannel Intraluminal Impedance in Healthy Children and Children With Gastroesophageal Reflux”: Comments

Clara Loots; Michiel van Wijk; Rachel van der Pol; Marije Smits; Marc Benninga; Taher Omari

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To the Editor: With interest we read the article by Di Pace et al, which describes esophageal motility patterns in healthy children and children with gastroesophageal reflux (GER) as assessed by multichannel intraluminal impedance (MII) (1). We, however, believe that the term “healthy children” is used inappropriately because all of the included patients underwent a 24-hour pH-MII study for the evaluation of GER symptoms and consequently are not healthy. The authors have grouped children into a healthy control group and a GER group, yet the exact criteria for this selection remain undefined. Identification of patients with GER was presumably based on adult normative data; however, these data are not transferable to children.
Patients with nonacidic reflux were excluded from the study, whereas pediatric studies have shown that nonacidic GER episodes are important in terms of the number of GER episodes and symptom association (2–4). Furthermore, compared with previous literature, the presented data suggest heavy selection because there is a substantially lower number of GER events (2–4).
In addition, data should be interpreted with caution, given the statistical tests used and the reporting thereof; for instance, in Table 1, it is not surprising that all of the parameters are statistically different because patient grouping was based on these criteria.
We believe that the conclusion drawn, stating that the data presented can serve as a reference value for healthy children, is not supported by the data.

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