Association Of Gastroesophageal Reflux Research Articles

Assessment of Gastroesophageal Reflux Symptoms and Sleep Quality Among Women in the Nurses’ Health Study II

Limited data exist on the association of gastroesophageal reflux (GER) symptoms with sleep quality. To prospectively investigate the association between GER symptoms and sleep quality. This prospective cohort study included data from the Nurses' Health Study II of female nurses in the US. Participants self-reported the frequency and duration of GER symptoms beginning June 2005, with updates every 4 years through June 2015. Follow-up was completed June 2019, and data were analyzed from November 15, 2022, to June 4, 2023. Frequency and duration of GER symptoms. Poor sleep quality was assessed in 2017 through a modified Pittsburgh Sleep Quality Index, which included difficulty in falling asleep, restlessness of sleep, daytime sleepiness, sleep disturbance, and sleep duration. Relative risk (RR) for poor sleep quality and individual components of poor sleep quality was estimated according to the frequency and duration of GER symptoms. Among 48 536 women (median age, 59 years [range, 48-69 years]), 7929 (16.3%) developed poor sleep quality during 4 years of follow-up. Compared with those with GER symptoms less than once a month, the multivariable RR for poor sleep quality among women with GER symptoms more than once a week was 1.53 (95% CI, 1.45-1.62). Women who had GER symptoms once or more a week for more than 7 years had an RR of 1.36 (95% CI, 1.30-1.43) compared with women who had not had GER symptoms once or more a week. The frequency and duration of GER symptoms were significantly associated with each individual component of poor sleep quality; for example, the multivariable RRs for GER symptoms 2 or more times per week compared with no GER symptoms were 1.49 (95% CI, 1.39-1.58) for difficulty in falling asleep, 1.47 (95% CI, 1.39-1.56) for excessive daytime sleepiness, and 1.44 (95% CI, 1.36-1.53) for restlessness of sleep. In this prospective cohort study of female nurses in the Nurses' Health Study II, the frequency and duration of GER symptoms were associated with subsequent risk of poor sleep quality. The findings suggest that effective treatment of GER disease may be important not only for improvement of symptoms but also for the reduction of comorbidities associated with poor sleep quality.

The relationship between gastroesophageal reflux disease and recurrent wheezing in children.

Gastroesophageal reflux disease occurs when gastric contents flow back into the esophagus and produce symptoms. Recurrent wheezing affects the quality of life for the patient and family. The association of gastroesophageal reflux with recurrent wheezing is suggested by different studies. The purpose of this study was to explore this relationship and to evaluate the outcome after appropriate treatment.A retrospective study on 85 children with recurrent wheezing, admitted in a pediatric gastroenterology regional center in Romania was performed. 24-hour continuous esophageal pH monitoring was used to evaluate the presence of gastroesophageal reflux and the results were interpreted using the Boix Ochoa score. All patients with positive score received treatment with proton pump inhibitors and they were evaluated again after 2 months.Gastroesophageal reflux was present in 71 children (83.5%), while 14 (16.5%) had a negative score, with a statistic significance (χ2 = 6.88, P = .0086, 95% confidence interval). After 2 months treatment with proton pump inhibitors, the Boix Ochoa score was still positive in 15 patients (21.13%).Recurrent wheezing is a solid reason for evaluating the presence of gastroesophageal reflux by 24-hour continuous esophageal pH-metry. Adequate treatment of gastroesophageal reflux solves also the recurrent wheezing in the majority of patients.

Association of gastroesophageal reflux and chest pain in children with mitral valve prolapse

Giriş ve Amaç: Göğüs ağrısı ve mitral kapak prolapsusu olan çocuklarda fonksiyonel gastrointestinal hastalıkların göğüs ağrısıyla ilişkisini araştıran az sayıda çalışma vardır. Bu çalışmada mitral kapak prolapsusu olan çocuklarda göğüs ağrısı ve gastroözofageal reflü hastalığı arasındaki ilişkiyi tanımlamayı amaçladık. Gereç ve Yöntem: Çalışmaya, tipik üst gastrointestinal sistem semptomları ve göğüs ağrısı tanımlayan, hafif ile orta mitral kapak prolapsusu olan 70 çocuk hasta dahil edildi. Hastalar sekiz hafta süreyle anti-reflü ilaç tedavisi ile tedavi edildi. Tedaviden önce ve sonra hastalar gastroözofageal reflü hastalığı etki ölçeği ile değerlendirildi. Bulgular: Hastaların yaş ortalaması 13.24±2.81 yıldı ve 32'si (%60) kızdı. 30 hastanın semptomları 6 haftadan daha fazla ve 40 hastanın semptomları 6 haftadan az süredir mevcuttu. Tüm hastaların ortalama semptom süresi 8±2.2 haftaydı. En çok bildirilen semptom göğüs ağrısı (%89.9) ve ardından regürjitasyon (%50) idi. Kronik gastroözofageal reflü olan çocuklarla karşılaştırıldığında, yeni gastroözofageal reflü tanısı alan çocuklarda anlamlı olarak daha sık ve ciddi semptomlar vardı. Mitral kapak prolapsusunun şiddeti ile semptomlar arasında anlamlı bir ilişki bulunmadı. Gastroözofageal reflü hastalığı etki ölçeği skorları, tedaviden sonra tüm hastalarda istatistiksel olarak azalmıştı (p <0.01). Her iki hasta grubu tedaviden fayda sağlasa da, gastroözofageal reflü hastalığı yeni saptanan hastalar, kronik hastalardan daha fazla tedaviden fayda gördüler. Sonuç: Mitral kapak prolapsusu ve göğüs ağrısı olan birçok çocuk hastada semptomatik gastroözofageal reflü hastalığı mevcuttur. Gastroözofageal reflünün spesifik tanısı ve tedavisi çoğu hastada göğüs ağrısını hafifletmiştir.

Association of Gastroesophageal Reflux With Malignancy of the Upper Aerodigestive Tract in Elderly Patients

ImportanceChronic inflammatory states have been linked to the development of malignancy. Gastroesophageal reflux disease (GERD) is a known risk factor for esophageal adenocarcinoma as the end result of chronic inflammatory changes.ObjectiveTo investigate the association of GERD with the risk of malignancy in the upper aerodigestive tract (UADT).Design, Setting, and ParticipantsWe used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to conduct a case-control study of individuals in the United States who had been added from January 2003 through December 2011 and were 66 years or older. The study included patients diagnosed with malignancy of the larynx, hypopharynx, oropharynx, tonsil, nasopharynx, and paranasal sinuses. GERD was examined as an exposure. Controls were matched from a 5% random sample of Medicare beneficiaries without cancer. Multivariable unconditional logistic regression was performed.Main Outcomes and MeasuresIncidence of invasive malignancies of the UADT.ResultsA total of 13 805 patients (median [range] age, 74 [66-99] years; 3418 women [24.76%] and 10 387 men [75.24%]) with malignancy of the UADT were compared with 13 805 patients without disease and were matched for sex, age group, and year of diagnosis. GERD was associated with a greater odds of developing malignancy of the larynx (adjusted odds ratio [aOR], 2.86; 95% CI, 2.65-3.09), hypopharynx (aOR, 2.54; 95% CI 1.97-3.29), oropharynx (aOR, 2.47; 95% CI, 1.90-3.23), tonsil (aOR, 2.14; 95% CI, 1.82-2.53), nasopharynx (aOR, 2.04; 95% CI, 1.56-2.66), and paranasal sinuses (aOR, 1.40; 95% CI, 1.15-1.70).Conclusions and RelevanceGERD is associated with the presence of malignancy of the UADT in the US elderly population. This epidemiological association requires further examination to determine causality and diagnostic utility.

Eosinophilic Esophagitis in Two Patients with Systemic Sclerosis.

The gastrointestinal tract (GIT) is the most common extracutaneous organ system damaged in systemic sclerosis (SSc) and is the presenting feature in 10% of patients. The esophagus as the portion of the GIT is the most commonly affected and there is an association of gastroesophageal reflux (GER) with SSc interstitial lung disease (ILD). Thus, an aggressive treatment for GER is recommended in all SSc patients with ILD; however, it is recognized that a long-term benefit to this treatment is needed to understand its impact. In this case report we discuss the presence of eosinophilic esophagitis (EoE) in two SSc patients and discuss the role for early EGD in SSc patients with moderate-severe GER symptoms for tissue study. Assessment of esophageal biopsy specimens for the presence of eosinophils and possibly ANA can help elucidate disease pathogenesis and direct therapy, as the presence of EoE in SSc has important management considerations, particularly with regards to dietary modification strategies.

SÍNTOMAS LARÍNGEOS Y LARINGITIS POSTERIOR: ¿SIEMPRE ES SECUNDARIO A REFLUJO GASTROESOFÁGICO?

Association of gastroesophageal reflux with posterior laryngitis. Study of 43 patients Background: Gastroesophageal reflux (GER) is syndicated as a cause of posterior laryngitis. However the evidence for the association is weak. Aim: To determine if the presence of posterior laryngitis is associated with GER. Material and Methods: Cross sectional study of 43 patients (19 males) with endoscopically confirmed posterior laryngitis derived for the study of GER. All patients underwent a clinical examination, upper gastrointestinal endoscopy, esophageal manometry and 24 hour pH monitoring. Results: Forty eight percent of patients had GER. Among 28 patients with dysphonia, 10 (36%) had heartburn and 11 (39%) had regurgitation. A hypotensive lower esophageal sphincter was associated with dysphagia in 100% of patients, regurgitation in 81%, cough in 100% and hoarseness in 87% of patients. Upper digestive endoscopy revealed the presence of esophagitis in 6 patients (14%) and was normal in the rest. Dysphonia had the best association with GER with a positive predictive value of 64%. Conclusions: Most patients with laryngeal symptoms and posterior laryngitis do not have GER.

Gastroesophageal Reflux and Body Movement in Infants: Investigations with Combined Impedance-pH and Synchronized Video Recording

The aim of this paper was to investigate the temporal association of gastroesophageal reflux (GER) and body movement in infants. GER were registered by combined impedance-pH, documentation of body movement was done by video. Videorecording time (Vt) was divided into “resting time” and “movement time” and analyzed for occurrence of GER. Association was defined as movement 1 minute before/after the beginning of a GER. Statistical evaluation was by Fisher's exact test. In 15 infants, 341 GER were documented during Vt (86 hours). 336 GER (99%) were associated with movement, only 5 episodes (1%) occured during resting time. Movement was significantly associated with the occurrence of GER (P < .0001). There is a strong temporal association between GER and body movement in infants. However, a clear distinction between cause and effect could not be made with the chosen study design. Combined impedance-pH has proven to be the ideal technique for this approach.

Induced Sputum Substance P in Children with Difficult-to-Treat Bronchial Asthma and Gastroesophageal Reflux: Effect of Esomeprazole Therapy

Objectives. To assess the induced sputum substance P (ISSP) levels in children having difficult-to-treat asthma (DA) with and without gastroesophageal reflux (GER). We aimed also to evaluate the association of GER with childhood DA, relationship of GER severity with childhood asthma control test (C-ACT), FEV1, peak expiratory flow (PEF) variability, and ISSP. Finally, we tried to evaluate esomeprazole treatment effect on C-ACT and FEV1 in children with DA. Methods. Spirometry, C-ACT, upper gastrointestinal endoscopy, and ISSP measurement were done for children with DA compared to healthy controls. Results. ISSP was high in DA with higher levels in the group having associated GER. In the latter group, ISSP and C-ACT improved significantly after esomeprazole treatment while FEV1 and PEF variability did not improve. Reflux severity was positively correlated with ISSP and negatively correlated with FEV1. Conclusions. GER was found in 49% of our patients with childhood DA. Very high ISSP levels in children with DA may be used as a marker for presence of GERD. Esomeprazole therapy improved asthma symptoms but did not improve lung function.

Association of Gastroesophageal Reflux and O2 Desaturation: A Novel Study of Simultaneous 24-h MII–pH and Continuous Pulse Oximetry

BackgroundProof of the relationship between gastroesophageal reflux disease (GERD) and respiratory symptoms remains a challenge. Our aim was to determine the association between reflux events and O2 desaturation in GERD patients with primary respiratory symptoms (RS) compared to those with primary esophageal symptoms (ES) using ambulatory monitoring systems. MethodsOne thousand eight hundred fifty-one reflux episodes were detected by multichannel intraluminal impedance (MII)–pH testing in 30 patients with symptoms of GERD (20 RS, ten ES.) All patients underwent simultaneous 24-h MII–pH and continuous O2 saturation monitoring via pulse oximetry. Reflux-associated desaturation events were determined by correlating synchronized 24-h esophageal pH and/or impedance and O2 desaturation. ResultsOne thousand one hundred seventeen reflux events occurred in patients with RS and 734 in those with ES. Nearly 60% of these 1,851 reflux events were associated with O2 desaturation. Markedly more events were associated with O2 desaturation in patients with RS (74.5%, 832/1,117) than in patients with ES (30.4%, 223/734, p < 0.0001). The difference in reflux desaturation association was more profound with proximal reflux—80.3% with RS vs. 29.4% with ES (p < 0.0001). ConclusionsA remarkably high prevalence of O2 desaturation associated with gastroesophageal reflux was noted in patients with RS. Given further study, simultaneous combined esophageal reflux and O2 saturation monitoring may prove a useful diagnostic tool in this difficult group of patients.

The effect of surgically created gastroesophageal reflux on intrapleural pressures in dogs

The causal relationship between gastroesophageal reflux (GER) and respiratory disorders is not well understood. Previous experimental studies that investigated this relationship were performed in anesthetized animals and used artificial acidification of esophagus for simulation of GER. In this study, we investigated the impact of GER on intrapleural pressures (IPP) in conscious, unanesthetized dogs. After the induction of appropriate anesthesia, 5 purpose-bred mongrel dogs underwent reflux-creating surgery (partial cardiomyectomy). The presence of GER was confirmed by determining the reflux index (RI) and the duration of longest reflux episode (DLRE) after 24-h intraesophageal pH-metry. IP was monitored before and after cardiomyectomy using a subcutaneously placed telemetric implant with its pressure-sensor catheter tip inserted into the pleural space. Partial cardiomyectomy resulted in a significant increase in RI from a preoperative mean value of 0.38 +/- 0.21 to 7.52 +/- 2.56%, and DLRE from 1.22 +/- 1.12 to 36.80 +/- 12.71 min, as recorded by the proximal sensor of the pH probe. A similar trend was observed at the distal sensor. After cardiomyectomy, the negative inspiratory IPP significantly increased from 17.2 +/- 7.9 to 28.4 +/- 9.7 mm Hg. A similar effect was observed in the negative expiratory IPP. The negative inspiratory IPP had a significant correlation with both RI (R = 0.932) and DLRE (R = 0.899). Cardiomyectomy causes GER, the severity of which correlates with negative inspiratory IPP in a dog model. The suggested model allows for the investigation of the pathologic association of GER with respiratory disorders in conscious animals.

M1524 Association of Gastroesophageal Reflux and O2 Desaturation in Patients with GERD; a Novel Study of Simultaneous 24-Hour Impedance-pH and Continuous Pulse-Oximetry

M1524 Association of Gastroesophageal Reflux and O2 Desaturation in Patients with GERD; a Novel Study of Simultaneous 24-Hour Impedance-pH and Continuous Pulse-Oximetry

Gastroesophageal reflux in infants < 32 weeks gestational age at birth: lack of relationship to chronic lung disease.

The objective of this study was to determine the incidence of gastroesophageal reflux (GER) as documented by extended esophageal pH monitoring in symptomatic premature infants and to identify its relationship with chronic lung disease (CLD). This was a retrospective study of 629 infants born < 32 weeks gestational age and admitted to the neonatal intensive care unit during the study period. Univariate analyses were done on the 137 infants undergoing the test for the association of the following risk factors with acid reflux: birth weight, gestational age, race, sex, length of stay, bronchopulmonary dysplasia (BPD; O2 requirement at 28 days), and severe CLD (O2 requirement at 36 weeks postmenstrual age). Eighty-seven of 137 infants were positive for GER. There was no association of GER with the risk factors studied, nor were there correlations with BPD or severe CLD. GER is common (63%) in premature infants < 32 weeks gestational age but clinical symptoms and CLD are poorly correlated with this diagnosis.

Supraesophageal complications of gastroesophageal reflux in children: challenges in diagnosis and treatment

Gastroesophageal reflux (GER) occurs throughout the day in healthy infants, children, and adolescents, as well as in adults. However, regurgitation into the pharynx and vomiting are more common in infants than in adults. This places the infant at particular risk for supraesophageal complications of GER. Despite recognition of this risk, a lack of good control data in children and an absence of placebo-controlled treatment trials provide only marginal evidence to support GER as a cause of any supraesophageal disorder in infants or children. An association of GER with “awake apnea,” reactive airway disease, and recurrent pneumonia has been demonstrated. Although there is no good evidence to support the efficacy of medical therapy, surgical therapy for GER has been demonstrated to improve symptoms in selected cases with each of these symptom presentations. Although clinical experience and case series suggest that GER may possibly contribute to laryngeal disorders, sinusitis, and otitis media, convincing data are lacking. No studies have definitively demonstrated symptom improvement with medical or surgical therapy for the latter symptom presentations.

Gastroesophageal reflux after repair of congenital diaphragmatic hernia

Background/Purpose: Mechanisms of postoperative gastroesophageal reflux (GER) remain unclarified in congenital diaphragmatic hernia (CDH). The aim of this study was to examine clinical features of CDH contributing to GER. Methods: GER was evaluated as esophageal acid exposure measured with 24-hour pH monitoring at the average age of 1.7 ± 0.9 months in 26 survivors of CDH. Correlations between the percentage total time pH below 4.0 (reflux index: RI)/number of long acid reflux (long reflux) and clinical features were investigated. The subjects were divided into 2 groups; group A: RI ≤ 4.0% (n = 7) and group B: R greater than 4.0% (n = 19). Clinical features were compared between the 2 groups. Results: No significant correlation was noted between RI/long reflux and birth weight, preoperative AaDO2, duration of artificial ventilation, and dimension of the defect. The incidence of direct closure was significantly higher, but use of nitric oxide inhalation and a presence of intrathoracic liver lobe herniation were significantly lower in group B. There was no significant difference of other clinical features indicating the severity of CDH between the 2 groups. Conclusion: An association of GER is not rare in early infancy after repair of CDH, which is influenced by the repair methods. J Pediatr Surg 37:1681-1684. Copyright 2002, Elsevier Science (USA). All rights reserved.

Gastroesophageal reflux: pathogenesis, diagnosis, and treatment.

Gastroesophageal reflux (GER) is a common problem confronting physicians involved in the care of children and adults. With the association of GER with asthma and chronic cough, physicians specializing in allergy/immunology require information on the pathogenesis, diagnosis, and management of GER. Eosinophilic esophagitis or eosinophilic gastroenteritis are poorly understood entities that may also lead to symptoms mimicking GER and are associated in many cases with underlying hypersensitivity of unknown immunologic mechanism.

Symptomatic gastroesophageal reflux in acutely hospitalized patients.

Patients admitted acutely to hospital may be at risk of increased morbidity and mortality as a result of gastroesophageal reflux and its complications. The recognized association of gastroesophageal reflux with cardiac and respiratory disease, the use of drugs that reduce lower esophageal sphincter pressure, and the supine position in which many patients are nursed may increase the risk of gastroesophageal reflux. This study aimed to determine the prevalence and severity of refluxlike symptoms in a series of consecutive unselected patients admitted acutely through the accident and emergency department of a district general hospital and to study the effect of hospitalization on these symptoms. Patients were interviewed by questionnaire on two occasions: immediately following admission and again 7-10 days later. The frequency of symptoms of heartburn, acid regurgitation, dysphagia, nausea, and belching were recorded on a 6-point scale, in addition to whether these symptoms occurred at night. Medication history, the number of days spent on bed rest, nasogastric intubation, and operation history were also recorded. In all, 275 patients were interviewed, of whom 229 had a second interview; 27% (62) had symptoms at least once a week (49% reported symptoms at least once a month) prior to admission, of whom 4% (9) had daily heartburn and/or acid regurgitation. Following admission to hospital there was a significant (P < 0.001) fall in the prevalence and frequency of refluxlike symptoms. There was a significant association of refluxlike symptoms with number of days spent in bed (P < 0.05) and with the use of nonsteroidal antiinflammatory drugs in hospital (P < 0.0001). Logistic regression analysis confirmed the association of NSAIDs with refluxlike symptoms. Nasogastric intubation and surgery were not associated with heartburn. In conclusion, symptoms of heartburn and acid regurgitation become less frequent following admission to hospital. This probably relates to a reduction in physical exertion following hospital admission but may reflect a reduction in anxiety levels or treatment of underlying disease. Patients on prolonged bed rest and those given non-steroidal anti-inflammatory drugs are at increased risk of refluxlike symptoms and may require antireflux measures.

Globus sensation is associated with hypertensive upper esophageal sphincter but not with gastroesophageal reflux.

Globus sensation (globus) is best described as a constant feeling of a lump or fullness in the throat. Although the etiology of globus remains unclear, it has been attributed to a hypertensive upper esophageal sphincter (UES) resting pressure and to gastroesophageal reflux (GER). The aim of this study was, therefore, to determine if significant associations existed among globus, UES resting pressure, and GER. We reviewed the records of all patients who had stationary esophageal manometry over a 21/2-year interval with specific attention to symptoms of globus, UES pressures, and ambulatory pH studies. Patients with hypotensive UES (<30 mm Hg) were excluded. Chi square (chi2) test was used to determine significant associations. Six hundred fifty patients had normal UES resting pressures and 101 patients had hypertensive UES (>118 mm Hg). Seventeen of the 650 (3%) (16 women/1 man; mean age: 48, range 32-81 years) with normal UES described globus. Conversely, 28 of the 101 (28%) (15 women/13 men; mean age: 43, range 23-61 years) patients with hypertensive UES described globus. There was a significant association between hypertonicity of the UES and globus (chi2=93.42, P < 0.0001). In patients with normal UES, globus occurred predominantly in females (chi2=6.33, P < 0.01). Twenty-three (16 women/7 men; mean age: 43, range 23-60 years) of the 45 patients with globus had prior ambulatory pH studies. Six of 23 (26%) had GER. Compared to an age-, sex-, and UES-pressure-matched group of 23 patients (16 women/7 men; mean age: 44, range 22-75 years) without globus, nine (39%) had GER, thus showing no significant association of globus with GER (P=0.35). There also was no significant association of GER with normal UES or with hypertensive UES in these patients. In conclusion, there is a significant association between hypertensive UES and globus. The data suggest two possible etiologies: female patients with normal UES pressure potentially having increased afferent sensation and a group with equal sex distribution but abnormally elevated UES resting pressure. This study does not support GER as an etiology of globus.

Introduction

Gastroesophageal reflux disease (GERD) is the most common malady of the esophagus. Complications of reflux disease involving structures proximally contiguous to the esophagus are now becoming a recognized clinical problem. For example, it is estimated that 4–10% of chronic nonspecific laryngeal diseases seen in otolaryngology clinics are associated with reflux disease. More striking perhaps is the association of gastroesophageal reflux with asthma and chronic cough. In addition to these specific disorders, a large number of other extra-esophageal conditions have been attributed to gastroesophageal reflux. Although the cause-and-effect relationship between reflux disease and the majority of these disorders has not been clearly established, clinical reports and (more recently) therapeutic trials and pH monitoring studies have brought this association into a clearer focus. The devastating consequences of retrograde aspiration of gastric contents into the lungs and its associated complications—such as pneumonia, pulmonary fibrosis, and abscess formation—have been recognized since the end of the last century.

Association of Gastroesophageal Reflux With Obstructive Lung Disease in Children After Allogeneic Bone Marrow Transplantation

Association of Gastroesophageal Reflux With Obstructive Lung Disease in Children After Allogeneic Bone Marrow Transplantation

Gastric emptying in children with gastroesophageal reflux. I. An estimate of effective gastric emptying

The association of gastroesophageal reflux (GER) and gastric emptying has been observed, but its importance is poorly understood. We compared 18- to 24-hour esophageal pH recordings with gastric emptying of radionuclide in apple juice in 109 children (2 weeks to 16 years old) referred for an evaluation of GER. A pH score and the pattern of GER (type I, II, and III) were obtained by esophageal pH monitoring. Gastric emptying was measured at 30 minutes (%GE30) and at 60 minutes (%GE60). The measured gastric emptying of apple juice was similar for the normal child and for those with GER regardless of pattern type. An inverse linear correlation between postcibal reflex and measured gastric emptying was demonstrated only by the eight asymptomatic children with a normal pH score (%GE30, r = -.9603, P less than .001; and %GE60, r = -.8263, P less than .05). If the contribution of postcibal reflux on gastric emptying was eliminated, then the effective gastric emptying was increased in many children with the type I (44%, P less than .05), type II (46%, P less than .05), or type III (60%, P less than .05) pattern of GER as compared with children with a normal reflux pattern (7%). In conclusion, measured gastric emptying of clear liquids is not necessarily decreased in most children with GER. Furthermore, many children with GER demonstrate an increased effective gastric emptying even though measured gastric emptying may not appear increased.