Pathologic reflux occurs when the reflux events increase in frequency or duration, when the refluxed material is not cleared from the esophagus, when the refluxed material is regurgitated and caloric loss ensues, or when the refluxate is noxious to the esophageal mucosa and causes esophagitis. The diagnosis of GER may be made based on a combination of clinical symptoms and history plus diagnostic work up. 24 hour monitoring is felt to be necessary to establish an accurate record. The number of reflux episodes considered as normal has not been well established. It may also identify severe esophagitis.
Radiation exposure is less than with barium swallow.
Regurgitant reflux is frequently missed. This may be performed in infants greater than 2 kg. It is useful in diagnosing esophagitis and may preclude the need to perform a pH probe study. Use is limited to infants with symptoms of esophageal dysmotility. For infants who present with symptoms of apnea, this study combines pH probe with heart rate and breathing patterns.