Esophagitis in distressed infants: poor diagnostic agreement between esophageal pH monitoring and histopathologic findings

J Pediatr. 2002 Jan;140(1):14-9. doi: 10.1067/mpd.2002.120695.


Objectives: Our purpose was to study the relation between gastroesophageal reflux (GER) and esophagitis in infants with persistent distress.

Study design: Infants (n = 125, 79 boys; median age, 4.2 months) with persistent distress and clinical symptoms suggestive of GER and esophagitis were retrospectively studied. All had undergone esophageal 24-hour pH monitoring and had upper gastrointestinal biopsy specimens taken.

Results: There were 65 (48%) infants with inflammatory changes found in at least one upper gastrointestinal biopsy specimen, of whom 32 (25.6%) had esophagitis; 11 infants with esophagitis also had gastritis or duodenitis. Although infants with frequent regurgitation (n = 65) had significantly more frequent GER episodes per 24 hours (P <.03) and greater fractional reflux time (P <.001) than infants without, this was not associated with histologic esophagitis (P =.33). Of the 32 infants with esophagitis, 9 had abnormal pH monitoring and 23 had nonreflux esophagitis. A separate group of 23 infants had abnormal pH monitoring but no esophagitis. Diagnostic agreement between pH monitoring and esophageal histologic features was poor (kappa = 0.07).

Conclusion: Esophagitis occurred in one quarter of infants with persistent distress. Abnormal esophageal pH monitoring did not reliably predict esophagitis, suggesting a nonacid peptic cause in some of these infants.

MeSH terms

  • Esophagitis / epidemiology
  • Esophagitis / etiology*
  • Esophagitis / pathology
  • Esophagus / metabolism
  • Female
  • Gastroesophageal Reflux / complications*
  • Humans
  • Hydrogen-Ion Concentration
  • Infant
  • Infant, Newborn
  • Male
  • Monitoring, Physiologic
  • Prevalence
  • Prognosis
  • Reproducibility of Results
  • Retrospective Studies