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Esophageal impedance monitoring: What a new test tells us about infants who reflux By: Judith M. Sondheimer, MD Contemporary Pediatrics DR. SONDHEIMER is professor of pediatrics, University of Colorado Health Sciences Center, and chief of pediatric gastroenterology, hepatology, and nutrition at The Childrens Hospital, Denver. She has nothing to disclose in regard to affiliations with, or financial interests in, any organization that may have an interest in any part of this article. The offices of pediatric gastroenterologists are filled with infants whose pediatricians have diagnosed gastroesophageal reflux disease. Infants with arching, crying, spitting, and food refusal are being diagnosed with GERD. Although these babies are treated with acid blockers and motility agents that are promoted as curative, a little digging shows that no double-blind controlled study has confirmed the efficacy of these drugs in controlling these symptoms in infants.1-3 No doubt, acid blockade cures esophagitis and produces dramatic changes in pH probe studies. But most infants with reflux do not have esophagitis, and treating a test result does not guarantee that symptoms will be controlled. There is a lack of pathophysiologic data explaining why infants reflux and whether GE reflux causes these common, frustrating symptoms. Recently, esophageal impedance monitoring has been introduced into the diagnostic armamentarium for GE reflux, and it promises to shed welcome light on the condition. Data are beginning to accumulate from studies on children. Whether these studies will translate into a clearer definition of disease and better control of symptoms in infancy remains to be seen. This article focuses on what impedance studies have revealed so far about infants with suspected reflux. Testing for reflux The tests most commonly used to document pathologic GE reflux in infants or to correlate symptoms with acid reflux are the barium radiograph, prolonged intraluminal esophageal pH