Routine Combined Esophageal Impedance and pH Measurement in Children T. G. Wenzl, M. Welter, E. Berkemeier, G. Heimann Kinderklinik, Universitätsklinikum Aachen, Germany PD Dr Tobias G. Wenzl, FRCPCH. Kinderklinik, Universitätsklinikum Aachen, Aachen, Germany 3 rd European Pediatric GI Motility Conference; Amsterdam, The Netherlands Gastroesophageal reflux (GER) is frequent in children. Pathology arises from associated symptoms, e.g. dysphagia and esophagitis, but also extraesophageal symptoms such as chronic cough, bronchitis and apnea. The old diagnostic "gold standard", pH monitoring, can only detect acidic (pH < 4) episodes. Non-acidic GER and laryngopharyngeal reflux (LPR) is concealed. Intraluminal impedance (IMP) has been shown to be a valuable tool for the complete, pH- independent detection of esophageal bolus movements in a series of pediatric studies (Wenzl, JPGN 2002 and Am J Med 2003). Conclusion: These are first data on the use of multiple intraesophageal impedance measurements in clinical routine in children. With the now available portable recording device (Sleuth, Sandhill Scientific, USA) and the ongoing development and validation of the automated analysis software the combined measurement of pH and impedance will replace the old standard of isolated pH monitoring and become the new "platinum standard" for complete GER / LPR detection. The role of extraesophageal reflux symptoms is being increasingly recognized, especially in infants and young children. Methods: Since January 2004 we routinely perform combined 24-hour esophageal impedance and pH measurements in all children presenting with symptoms suggestive of reflux and an indication for a long-term reflux study. We use a single catheter with 6 impedance channels and 1 pH channel, with the impedance channels spanning from the pharynx to the distal esophagus. Results: So far, combined routine studies were performed in 69 children (median age 2.2 years, range years). In 50 patients (72%) pH- data showed normal findings. However, in 37 patients with non-acidic GER/LPR documented by IMP an association with the individual symptoms could be demonstrated. Patient age varied remarkably between presenting symptoms: gastrointestinal symptoms, n = 24, median age 6.6 (range years); pulmonary symptoms, n = 35, median age 1.2 (range years); neurological symptoms, n = 10, median age 0.7 (range years). Case report: An infant with abnormal movements and dystonia was treated with anticonvulsants for suspected atypical cerebral seizures. EEG and computed tomography of the brain showed normal findings. A 24hour-pH-impedance study demonstrated a clear temporal association between the child´s symptoms and acidic GER reaching the hypopharynx (Sandifer´s syndrome). Under therapy with PPI the infant became asymptomatic and the anticonvulsive treatment could be discontinued. This case underlines the importance of a combined measurement of pH and bolus movement.