Abstract
Purpose: The high incidence of gastroesophageal reflux disease (GERD) in neurologically impaired (NI) patients, which affects their QOL and mortality, is well recognized. However, the evaluation of gastroesophageal reflex (GER) in NI patients is difficult because they cannot describe their symptoms precisely. pH monitoring, which has been widely used to evaluate GER, cannot detect non-acid reflux. We used 24 h multichannel intraluminal impedance-pH monitoring (MII/pH), which is not affected by the pH of refluxed materials. The aim of this study was to evaluate the features of GER in NI patients using MII/pH.
Methods: Six NI patients (4 males, 2 females) with a median age of 15.5 years (range, 12–28 years) underwent MII/pH. One patient was fed orally, 4 were fed nasogastrically and 1 was fed via a gastrostomy tube. pH index, bolus exposure index, acid reflux/non-acid reflux and proximal reflux were analyzed in each of the patients.
Results: There were 499 reflux episodes in total during the study period, of which 440 (88.1%) were acid reflux and 59 (13.4%) were non-acid reflux. The pH index was higher than the cutoff value (4.0 in 5 patients). The bolus exposure index was also higher than the cutoff value (1.4 in 5 patients). Although the number of acid reflux episodes was larger than that of non-acid reflux episodes, non-acid reflux was observed in all the patients. The percentage of proximal reflux episodes was higher than 50% in 3 patients.
Conclusions: Non-acid reflux is also involved in GER in NI patients. It is suggested that MII/pH is useful for the evaluation of GER in those patients.
