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Journal of the Korean Child Neurology Society 2007;15(1):75-82.
Published online May 30, 2007.
Esophageal pH Monitoring in Pediatric Patients with Neurodevelopmental Disabilities.
Soon Chul Kim, Sun Jun Kim
Department of Pediatrics, Chonbuk National University Medical School, Jeonbuk, Korea. sjkim@chonbuk.ac.kr
Neurologically impaired children like cerebral palsy(CP) often complain of gastrointestinal dysfunction such as dysphagia, vomiting, constipation, dysfunctional feeding patterns and gastroesophageal reflux(GER). The aim of our study was to evaluate the significance of esophageal 24 hour pH monitoring compared with barium esophagography in pediatric patients with neurodevelopmental disabilities. METHODS: We applied 23 children on 24 hour pH monitoring. Their mean age was 4 years and 3 months(male to female of 15:8). Six patients had spastic quadriplegia and other six had hypotonic CP. Eleven patients had neurodevelopmental disabilities due to seizure, metabolic disorder, neuromuscular disease, brain tumor and progressive encephalopathy. All of the patients suffered from chronic recurrent bronchitis and four of them had been fed by tubes(gastrostomy). RESULTS: Two out of 23(8.7%) were diagnosed as pathologic GER by esophagography with barium. By the reflux index(time % of below pH 4), 8 patients(34.8%) were diagnosed as GER. The incidence of GER in the spastic CP group was significantly higher than the hypotonic CP group(P=0.003). Patients(n=15) with abnormal brain MRI(magnetic resonance image) findings showed a higher incidence of GER than the normal neuroimaging group (P=0.002). The oral feeding group showed a higher incidence for pathologic GER than the tube feeding(gastrostomy) group(P=0.021). CONCLUSION: These results suggest that esophageal 24 hour pH monitoring is recommended as a feasible diagnostic method for the evaluation of GER in the pediatric patients with neurodevelopmental disabilities.
Key Words: Cerebral palsy, Esophageal pH monitoring, Gastroesophageal reflux, Hypotonic cerebral palsy, Spastic cerebral palsy


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