Abstract
Crying babies present many diagnostic dilemmas. We studied 10 infants, ages 5-24 months (mean 10.8 mo.) who presented with persistent nocturnal crying;some also with postprandial irritability. None had vomiting or weight loss.Mean duration of symptoms was 5.5 mos. Criteria for a GE reflux workup included severe disruption of family life and failure to respond to a milk and soy free diet. Methods: Infants were evaluated by GI series, overnight intraesophageal pH monitoring, and endoscopy. Results:Upper GI series revealed no anatomical abnormalities and significant GE reflux in 3 patients. Overnight pH probe study showed abnormal acid clearance in all patients, correlating with crying and irritability. Endoscopy and biopsy revealed esophagitis in one patient. Follow-up: All patients responded to antacid therapy. 6-24 months after therapy indicates no evidence for recurrence of GER, or chronic esophagitis. Conclusions:1. GER is an important and not uncommon cause of the nocturnal and/or postprandial irritability in infancy.2. Intraesophageal pH probe monitoring appears to be the best method for detecting GER in these patients and correlates well with symptoms. 2. Only 1/10 (10%) of patients had esophagitis on biopsy. 4. None have progressed to chronic esophagitis.
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