Various diagnostic methods have been designed and developed over the years to discriminate between physiologic and pathologic gastroesophageal reflux. Though pH-metry has been used for years, its benefits and limitations became clearer with time and newer diagnostic techniques like wireless methods (Bravo pH capsule), pharyngeal probes, and multichannel intraluminal impedance with pH (MII-pH) to measure both acid and nonacid reflux (NAR) were introduced. Evidence indicates that MII-pH seems to be the new gold standard for the evaluation of patients with extraesophageal symptoms of suspected gastroesophageal reflux disease (GERD) or in patients with persistent symptoms despite acid suppression therapy however the lack of true pediatric normal reference values and limited therapeutic options for NAR is a major issue. The technique to perform MII-pH-metry has been described in this article.
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