725 ASSOCIATION BETWEEN DIURNAL BASELINE IMPEDANCE LEVELS AND ESOPHAGEAL CLEARANCE IN CHILDREN

WITH FUNCTIONAL ESOPHAGEAL DISORDERS. Lucina Gordillo Rodríguez, Erick Toro Monjaraz, Jaime Ramírez-Mayans, Flora Zárate-
Mondragón, Ericka Montijo-Barrios, Karen Ignorosa-Arellano, José Cadena-León, Roberto Cervantes Bustamante
Gastroenterology, Instituto Nacional de Pediatría, Ciudad de México, Coyoacan, Mexico
Introduction: Non-erosive reflux disease (NERD) is a condition that occurs in patients that present esophageal symptoms although with no evidence

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of esophagitis during endoscopy. NERD is the most frequent presentation of gastroesophageal reflux disease (GERD). NERD can be divided into
true NERD (abnormal acid esophageal exposure), reflux hypersensitivity (normal acid exposure with symptoms association), and functional
heartburn (negative acid exposure and no symptoms association). The physiopathology is unknown, which is why we want to determine the
association between impedance-pH monitoring in these groups of patients. Baseline impedance is a parameter associated with esophageal mucosal
integrity and increased acid sensitivity.
Objectives: Compare all pH-impedance metrics, especially esophageal clearance, diurnal (MDBI), and nocturnal baseline impedance (MNBI) in
distal channels in children with NERD.
Methods: Descriptive, retrospective study of children with GERD symptoms, from January 2015 to December 2022. All patients underwent upper
endoscopy showing normal esophagus mucosa and pH-impedance monitoring. Mean baseline impedance was assessed in distal channels (5-6) in 3
hours during daytime (08:00-11:00 hrs.) and nighttime (01:00-04:00 hrs.). Esophageal clearance was calculated using the Sandhill software
impedance-pH monitoring system. Frequencies and percentages were reported as descriptive measurements. For multivariate comparison between
the groups, T-student and Anova were performed.
Results: We included 40 children, nineteen patients were males (M) (47.5%), and 21 were females (F) (52.5%). The sample was divided into three
groups: 12 children were assigned to the true NERD, 18 to the reflux hypersensitivity, and 10 to the functional heartburn. There were no significant
differences in age and gender between them, but females were more common in the last one.
In the first group, 91% of the children had regurgitations. Dysphagia was the most prevalent symptom in the second group, present in 55% of the
patients (p<0.006). Finally, early satiety was present in 50% of the patients in the third group (p<0.018).
The mean reflux index in the first group was 12 ± 2.38, in the second was 1.7 ± .35 and in group 3 was 2.34 ± 1.03,
There were differences between the three groups in the longest episode of reflux and the total acidic reflux measured by impedance; however, we
didn’t find differences in the weekly acidic reflux and non-acidic reflux between the groups (p<0.063 and p<0.782, respectively).
Group 1 compared with group 2 showed higher values in esophageal clearance in decubitus (media 389.3 ±141.8 vs 35.2 ± 9.1; p<0.005) and total
esophageal clearance (media 159.7 ±34.1 vs 49.7 ± 10.7; p<0.001) (figure 1). Concerning the mean diurnal baseline impedance in channel six we
found differences between the three groups, p<0.018 (G1: 1862.17 ± 290.10, G2: 2828.17 ± 211.54, G3: 2793.90 ± 275.58) (figure 2).
Similarly, Group 1 vs Group 3 showed increased levels of esophageal clearance in decubitus (media 389.3 ± 141.8 vs 60.7 ± 29.8; p<0.018), and
MDBI (C6) showed lower levels (p<0.033). When we compared the three groups, we found differences in esophageal clearance in decubitus
(p<0.003) and total (p<0.004), revealing low esophageal clearance in the NERD group.
Conclusions: Impedance-pH monitoring is essential for the diagnosis of NERD. Some parameters are affected in patients with true NERD compared
with functional esophageal disorders. Our study demonstrated that esophageal clearance and diurnal baseline impedance are altered in the true NERD
group. We should establish the relevance of non-acid reflux in functional esophageal diseases.

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