The significance of gastroesophageal reflux patterns in children

Abstract

We studied 93 consecutive children less than 2 yr old who had symptoms of gastroesophageal reflux (GER) and abnormal patterns of reflux during 18–24 hr esophageal pH monitoring. The abnormal patterns of reflux were classified as continuous (type I, N=52), discontinuous (type II, N=33), and mixed (type III, N=8). Seventy-seven children were followed for at least 18 mo (average of 30 mo), with repeat esophageal pH studies in 60. Conservative medical therapy was tried in all children, but in 39% (30/77) an antireflux operation was performed to control symptoms. Reflux resolved spontaneously during medical therapy in 63% of children (17/27) with the type II reflux pattern as compared to only 21% (9/42, p<0.001) with the type I pattern and 13% (1/8, p<0.05) with the type III pattern. The abnormally high frequency and prolonged duration of reflux usually remitted by 10 mo of age, suggesting a period of postnatal esophageal maturation in affected children. In addition, children with the type II pattern of reflux often had impaired gastric emptying related to spasm of the antrum or pylorus. Identification of a type I or III pattern of reflux in symptomatic children significantly reduced the chance that GER would resolve spontaneously; with 50% (25/50) of these children eventually requiring an operation to control symptoms. However, in children with a type II pattern of reflux, GER usually resolved without operative therapy. We studied 93 consecutive children less than 2 yr old who had symptoms of gastroesophageal reflux (GER) and abnormal patterns of reflux during 18–24 hr esophageal pH monitoring. The abnormal patterns of reflux were classified as continuous (type I, N=52), discontinuous (type II, N=33), and mixed (type III, N=8). Seventy-seven children were followed for at least 18 mo (average of 30 mo), with repeat esophageal pH studies in 60. Conservative medical therapy was tried in all children, but in 39% (30/77) an antireflux operation was performed to control symptoms. Reflux resolved spontaneously during medical therapy in 63% of children (17/27) with the type II reflux pattern as compared to only 21% (9/42, p<0.001) with the type I pattern and 13% (1/8, p<0.05) with the type III pattern. The abnormally high frequency and prolonged duration of reflux usually remitted by 10 mo of age, suggesting a period of postnatal esophageal maturation in affected children. In addition, children with the type II pattern of reflux often had impaired gastric emptying related to spasm of the antrum or pylorus. Identification of a type I or III pattern of reflux in symptomatic children significantly reduced the chance that GER would resolve spontaneously; with 50% (25/50) of these children eventually requiring an operation to control symptoms. However, in children with a type II pattern of reflux, GER usually resolved without operative therapy.