Please cite this article in press as: Quitadamo P, et al. Esophageal pH-impedance monitoring in children: position paper on indications, methodology and interpretation by the SIGENP working group. Dig Liver Dis (2019), https://doi.org/10.1016/j.dld.2019.07.016 ARTICLE IN PRESS G Model YDLD-4156; No. of Pages 15 Digestive and Liver Disease xxx (2019) xxx–xxx Contents lists available at ScienceDirect Digestive and Liver Disease jou rnal h om epage: www.elsevier.com/locate/dld Position Paper Esophageal pH-impedance monitoring in children: position paper on indications, methodology and interpretation by the SIGENP working group Paolo Quitadamo a,b,∗ , Renato Tambucci c,d , Valentina Mancini e , Fernanda Cristofori f , Mariella Baldassarre g , Licia Pensabene h , Ruggiero Francavilla f , Giovanni Di Nardo i , Tamara Caldaro c , Paolo Rossi j , Saverio Mallardo j , Elena Maggiora k , Annamaria Staiano b , Francesco Cresi k , Silvia Salvatore l , Osvaldo Borrelli m a Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Naples, Italy b Department of Translational Medical Science,“Federico II”, University of Naples, Italy c Digestive Endoscopy and Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy d Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy e Department of Pediatrics and Neonatology, Saronno Hospital, Saronno, Italy f Department of Pediatrics, Giovanni XXIII Hospital, Aldo MoroUniversity of Bari, Bari, Italy g Department of Biomedical Science and Human Oncology-neonatology and Nicu section, University “Aldo Moro”, Bari, Italy h Department of Medical and Surgical Sciences, Pediatric Unit, University “Magna Graecia” of Catanzaro, Catanzaro, Italy i NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, Rome, Italy j Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy k Neonatology and Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy l Pediatric Department, Ospedale ¨ F. Del Ponte ¨ , University of Insubria, Varese, Italy m Division of Neurogastroenterology and Motility, Department of Paediatric Gastroenterology, UCL Institute ofChild Health and Great OrmondStreet Hospital, London, UK a r t i c l e i n f o Article history: Received 15 May 2019 Accepted 20 July 2019 Available online xxx Keywords: Gastro-esophageal reflux pH-impedance Children Infants a b s t r a c t Multichannel intraluminal impedance pH (MII-pH) monitoring currently represents the gold standard diagnostic technique for the detection of gastro-esophageal reflux (GER), since it allows to quantify and characterize all reflux events and their possible relation with symptoms. Over the last ten years, thanks to its strengths and along with the publication of several clinical studies, its worldwide use has gradually increased, particularly in infants and children. Nevertheless, factors such as the limited pediatric reference values and limited therapeutic options still weaken its current clinical impact. Through an up-to-date review of the available scientific evidence, our aim was to produce a position paper on behalf of the working group on neurogastroenterology and acid-related disorders of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) on MII-pH monitoring technique, indications and interpretation in pediatric age, in order to standardise its use and to help clinicians in the diagnostic approach to children with GER symptoms. © 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved. 1. Introduction Multichannel intraluminal impedance pH (MII-pH) monitoring currently represents the gold standard diagnostic technique for On behalf of the working group on Neurogastroenterology and Acid-related Dis- orders of the Italian Society for Pediatric Gastroenterology, Epatology, and Nutrition (SIGENP) ∗ Corresponding author at: Department of Pediatrics, A.O.R.N. Santobono- Pausilipon, Via Mario Fiore 6, 80100 Naples, Italy. E-mail address: paoloquitadamo@yahoo.it (P. Quitadamo). the detection of gastro-esophageal reflux (GER), since it allows to quantify and characterize all reflux events and their possible rela- tion with symptoms [1]. MII-pH monitoring provides an accurate assessment of the number of both acid and non acid GER episodes, the acid esophageal exposure percent time, the height and com- position of the refluxate (liquid, gas, or mixed contents). It also recognizes swallows from reflux episodes, measures the bolus and acid clearance time, and assesses the temporal association between reflux episodes and symptoms occurring during the study period. Over the last ten years, thanks to its strengths and along with the https://doi.org/10.1016/j.dld.2019.07.016 1590-8658/© 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.