GASTROESOPHAGEAL REFLUX(GER) IN CYSTIC FIBROSIS (CF)

Abstract

GER is a recognized problem in CF. The aim of this study was to define the frequency of GER in a clinic population of CF patients and to assess the effect of supplemental nocturnal nasogastric (NG) feedings on the frequency of GER. Children in the CF Clinic were surveyed to determine the incidence of symptomatic GER. A subgroup of patients with poor nutritional status were studied with esophageal manometry and 24-hr esophageal pH recording before and after initiation of supplemental continuous night-time NG feeds. Of 68 CF patients ≥5 yr of age (13.1±7.1 yr, x±SD) 20.6% experienced regurgitation and 26.5% heartburn. There was no significant association between symptoms of GER and bronchodilator therapy. Eight patients studied with manometry and 24-hr pH recording (15.5±6.6 yr) had normal lower esophageal sphincter pressure of 24.8±8.8 mmHg and thoracoabdominal pressure gradient of 11.4±4.6 mmHg. Peristalsis and upper esophageal sphincter function were normal. There was a significant increase in reflux episodes, episodes >5 min duration, and % time esophageal pH was <4 in CF patients compared to published control data for the entire 24-hr period or during sleep. During sleep continuous NG feedings significantly increased episodes of reflux. Our findings indicate that symptoms of GER, heartburn and regurgitation, are frequent in CF patients and when quantitated by 24-hr esophageal pH monitoring GER is significantly more common in CF compared to controls. GER was not related to bronchodilator therapy but was aggravated by night-time NG feedings.