Gastroesophageal Reflux In Infants Research Articles

A preliminary report on the efficacy of the Multicare AR-Bed in 3-week–3-month-old infants on regurgitation, associated symptoms and acid reflux

Objectives:The aim of this preliminary study was to evaluate the efficacy of a 40° supine body position on infant regurgitation, reflux-associated symptoms and acid reflux.Intervention:Thirty of 52 consecutive infants presenting...

Gastroesophageal Reflux in Severe Cases of Robin Sequence Treated with Nasopharyngeal Intubation

To study the prevalence of abnormal gastroesophageal reflux in infants with Robin sequence who had severe respiratory obstruction treated with nasopharyngeal intubation and to evaluate the efficacy of nonsurgical treatment. Longitudinal prospective study. Hospital de Reabilitação de Anomalias Craniofaciais, University of São Paulo, Brazil. Twenty infants with severe isolated Robin sequence treated with nasopharyngeal intubation. We performed 24-hour esophageal pH monitoring on each child at 2, 4, and 6 months of age. Respiratory and feeding status were evaluated. We considered abnormal gastroesophageal reflux as reflux index values above the 95th percentile of the Vandenplas reference for normal children. The prevalence of reflux index above the 95th percentile at the first exam was 6/20, a value significantly higher than the reference (5/103, p < .01). At the second and third exams, reflux index values were decreased. Ninety percent of the infants showed improvement of respiratory difficulty and developed oral feeding capacity. The prevalence of abnormal gastroesophageal reflux is higher in infants with severe cases of Robin sequence than in normal infants. Nonsurgical procedures improved respiratory and feeding difficulties of most of these infants.

Prevalence and Natural History of Gastroesophageal Reflux: Pediatric Prospective Survey

The prevalence and natural history of gastroesophageal reflux in infants have been poorly documented. The aim of this study was to evaluate the prevalence and natural history of infant regurgitation in Italian children during the first 2 years of life. A detailed questionnaire, according to the Rome II criteria, was completed by 59 primary care pediatricians to assess infant regurgitation in consecutive patients seen in their office over a 3-month period. A total of 2642 patients aged 0 to 12 months were prospectively enrolled during this 3-month period. Follow-up was performed at 6, 12, 18, and 24 months of age. A total of 313 children (12%; 147 girls) received the diagnosis of infant regurgitation. Vomiting was present in 34 of 313 patients. Their score for the Infant Gastroesophageal Reflux Questionnaire was 8.51 +/- 4.75 (mean +/- SD). Follow-up visits were conducted to the end in 210 of 313 subjects. Regurgitation had disappeared in 56 of 210 infants by the first 6 months of age, in 128 by the first 12 months, in 23 at 18 months, and in 3 patients by the first 24 months. At follow-up, 1 of 210 patients had developed a gastroesophageal reflux disease with esophagitis, proven endoscopically and histologically; another patient received a diagnosis of cow milk protein intolerance. The Infant Gastroesophageal Reflux Questionnaire score reached 0 after 8.2 +/- 3.9 months in breastfed infants (89 of 210) and after 9.6 +/- 4.1 months in artificially fed infants. We found that 12% of Italian infants satisfied the Rome II criteria for infant regurgitation. Eighty-eight percent of 210 infants who had completed a 24-month follow-up period had improved at the age of 12 months. Only 1 patient later turned out to have gastroesophageal reflux disease. Use of breast milk was associated with a shorter time necessary to reach an Infant Gastroesophageal Reflux Questionnaire score of 0.

Natural History of GER in Infants

Few studies have reported on the natural history of gastroesophageal reflux (GER) in infants. To examine the prevalence and natural history of infant GER, 59 primary care pediatricians in Italy prospectively assessed consecutive healthy infants (age range, 1–12 …

The Effect of Thickened-Feed Interventions on Gastroesophageal Reflux in Infants: Systematic Review and Meta-analysis of Randomized, Controlled Trials

Currently, thickened feeds are increasingly being used to treat infants with gastroesophageal reflux, driven in large part by the baby food industry. Previous meta-analyses have shown that although thickened formulas do not seem to reduce measurable reflux, they may reduce vomiting. However, because data are limited, there is still uncertainty regarding the use of thickening agents. Our goal was to systematically evaluate and update data from randomized, controlled trials on the efficacy and safety of thickened feeds for the treatment of gastroesophageal reflux in healthy infants. The Cochrane Library, Medline, Embase, and CINAHL databases and proceedings of the European and North American pediatric gastroenterology conferences (from 2000) were searched in May 2008; additional references were obtained from reviewed articles. Only randomized, controlled trials that evaluated thickened feeds used in infants for at least several days for the treatment of gastroesophageal reflux were considered for inclusion. Three reviewers independently performed data extraction by using standard data-extraction forms. Discrepancies between reviewers were resolved by discussion between all authors. Only the consensus data were entered. Fourteen randomized, controlled trials with a parallel or crossover design, some with methodologic limitations, were included. Use of thickened formulas compared with standard formula significantly increased the percentage of infants with no regurgitation, slightly reduced the number of episodes of regurgitation and vomiting per day (assessed jointly or separately), and increased weight gain per day; it had no effect on the reflux index, number of acid gastroesophageal reflux episodes per hour, or number of reflux episodes lasting >5 minutes but significantly reduced the duration of the longest reflux episode of pH<4. No definitive data showed that one particular thickening agent is more effective than another. No serious adverse effects were noted. This meta-analysis shows that thickened food is only moderately effective in treating gastroesophageal reflux in healthy infants.

Composition and fortification of human milk influence gastroesophageal reflux in preterm infants

Composition and fortification of human milk influence gastroesophageal reflux in preterm infants

Clinical Response to 2 Dosing Regimens of Lansoprazole in Infants With Gastroesophageal Reflux

Proton pump inhibitors such as lansoprazole are used in the treatment of gastroesophageal reflux disease (GERD), but dosing guidelines for infants have not been determined. The objective of this study was to assess the clinical efficacy of 2 dosing regimens of lansoprazole in infants with GERD using the revised infant gastroesophageal reflux questionnaire scores (I-GERQ-R). Thirty consecutive infants (3-7 months) with GERD, whose conditions were diagnosed by I-GERQ-R scores of > or =16, were randomly assigned to receive 1 of 2 lansoprazole dosing regimens: 15 mg given once per day (group A) or approximately 7.5 mg given 2 times per day (group B). Matched infants in a control group were treated with an extensively hydrolyzed formula (group C). Daily I-GERQ-R scores were gathered, and the scores after 1 and 2 weeks of treatment were used for analysis. The mean pretreatment scores were similar in groups A, B, and C (26.6, 26.9, and 25.9, respectively). After treatment there was a similar drop in the mean scores in groups A and B (20.6 and 20.0, respectively), but not in group C (25.8). At the end of the first week of treatment, in group A, 5 of 15 infants (33%) had a significant reduction in their I-GERQ-R scores, whereas in group B, 10 of 15 infants (67%) had a significant reduction in their I-GERQ-R scores (P < 0.05). At the end of the second week of treatment, groups A and B had similar numbers of patients with significant improvement (60% and 67%), which was higher than in group C (3/15, 20%). Overall, there was no difference in the symptom response, as measured by I-GERQ-R scores, between 15 mg of lansoprazole given once per day and 7.5 mg given twice per day in infants with GERD, but the twice-daily regimen produced a faster symptom response. Both regimens were significantly better than treatment of infants with an extensively hydrolyzed formula.

Gastroesophageal Reflux: Are There Differences of Characteristic in Infants and Children

Background: Gastroesophageal reflux (GER) is an involuntary passage of gastric contents into the esophagus. GER in infancy is usually a physiologic reflux whereas GER in children more than 12 months old is often considered as a pathologic reflux although without any clinical complications. This consideration may lead over-treatment of GER in children. The objective of this study was to find out the difference of GER characteristic in ‘healthy’ infants and children. Method: Cross sectional study in children age 0-36 months at Cipto Mangunkusumo Hospital Jakarta during 2005-2007 with inclusion criteria: clinically healthy, regurgitations/vomits ³ 4 times/day, well nourished and other etiologies of vomiting had been excluded. The characteristic of GER was evaluated by esophageal pH monitoring (pH-metri) included number of reflux episodes, reflux duration > 5 minutes, and reflux index. Results: Sixty children were enrolled in the study; consisting 30 infants (age 0-12 months) and 30 children (age 13-36 months). The median number of reflux in infants was 18 ( range1-19), whereas the median in children was 17 (range 3-27) ( p = 0.47). The median number of reflux > 5 minutes was 2 (range 0-2), whereas the median in children was 3 (0-30) (p = 0.85). The median reflux index in infants was 4.5% (range 0.6%-22.9%) whereas the median in children was 6.35% (0.1%-87.%) (p = 0.34). Conclusion: The characteristic of GER in ‘healthy’ infants and children were not significantly different; however reflux index > 5% (pathologic GER) was seen in children age 13-36 months. Clinical course monitoring are important in infants and children with GER. Keywords: gastroesophageal reflux, regurgitation, infant, children, pH monitoring

Gastroesophageal reflux in infants and children

Gastroesophageal reflux disease (GERD) is the most common esophageal disorder and the most frequent reason why infants are referred to the pediatric gastroenterologist, affecting as much as 30% of the pediatric population. Presenting features of GERD in infants and children are quite variable and follow patterns of gastrointestinal and extra-esophageal manifestations that vary between individual patients and may change according to age. Patients may be minimally symptomatic, or may exhibit severe esophagitis, bleeding, nutritional failure, or severe respiratory problems. GERD is also complex for the diagnostic techniques required to assess its repercussions or explain its origin. Although different abnormalities in motility variables, such as lower eso-phageal sphincter (LES) function, esophageal peristalsis and gastric motor activity can contribute to the development of GERD, the degree of esophageal acid exposure represents the key factor in its pathogenesis. Esophageal pH monitoring, based on both the detection of acid reflux episodes and the measurement of their frequency and duration, has been regarded as the most sensitive and specific diagnostic tool for diagnosing reflux disease. The aim of this paper is to give a concise review for the clinicians encountering this specific disease in infants and children.

Authors' Response to Letter

To the Editor: We thank Dr Indrio and colleagues for their letter, which makes a number of salient points in reference to our manuscript on the effects of omeprazole in premature neonates with pathological esophageal acid exposure (1). We begin by reiterating that the principal aim of our study was to assess the safety and efficacy of omeprazole for the reduction of acid gastroesophageal reflux in premature infants with gastroesophageal reflux disease (GERD). Indrio et al correctly point out that the appropriateness or otherwise of the cutoff criteria of reflux index >5% to indicate pathological esophageal acid exposure is a matter of conjecture. Most pediatric centres would routinely use 5%; however, a fair reading of the limited literature that reports 24-hour pH studies in healthy infants indicates that higher cutoff criteria of 10% may be more appropriate. It is, however, not true that 8 of the infants enrolled in our study had a reflux index of between 5% and 7%. As our Figure 1 clearly shows, 7 of the 10 infants had a reflux index >10% on placebo, with 3 >20% (average 19% overall). Hence, measured acid exposure off-therapy was highly significant and not equivocal. When on proton pump inhibitor (PPI) therapy, the reflux index was reduced to ≤5% in 9 of the 10 infants (average, 4.9%). We, therefore, demonstrated that a once-daily dose of 0.7 mg/kg omperazole “normalised” the reflux index, the precise criteria applied had no impact on this major finding or the conclusions drawn from this study. The lack of symptomatic improvement, despite normalisation of esophageal acid exposure levels, was both disappointing and counterintuitive. We reiterate that this negative finding needs to be treated with caution due to limitations in the study design related to the accuracy of recording of symptomatic episodes and the 1-week treatment period which may have been too short. We do not believe the lack of symptomatic change relates to our specific diagnostic criteria because stratification of our patients, based on severity of esophageal acid exposure on placebo and/or magnitude of change in esophageal acid exposure with therapy, still failed to show significant symptomatic changes. We do not agree with the suggestion that the lack of a clinical response to omeprazole may have related to age at the time of study and whether our patients were technically preterm or term. The postmenstrual age of our patients ranged from 34 to 40 weeks, and the suggestion that specific reflux index criteria be developed across this age range seems futile given the high level of variability in this parameter. This is due to a number of factors that may influence the reflux index including feed type, feed frequency and volume, nasogastric tube placement, and xanthine therapy. Indeed, this highlights yet another limitation of reflux index as a diagnostic parameter. The most obvious explanation for the lack of symptomatic response relates to the fact that a “proven” association of symptoms with gastroesophageal reflux episodes was not a selection criterion. GERD in infants is a complex disorder due to the range of clinical presentations, and the causal relationship between significant acid exposure and clinical symptoms is often difficult to prove. Rather than relying on measurement of acid exposure based on arbitrary reflux index criteria, the ability to demonstrate a temporal association between individual reflux events and the onset of symptomatic episodes would, in our view, be more diagnostically useful. Intraluminal pH-impedance monitoring allows detection of all reflux independently of pH and, as already demonstrated in adults on and off PPI therapy, improves the accuracy of reflux-symptom associations (2,3). Similar studies in infants have yet to be published; however, given the increased prevalence of nonacid bolus reflux in infants due to frequent milk/formula feeding, it is our expectation that pH-impedance monitoring will improve the diagnostic yield over and above pH monitoring alone. The present lack of appropriate diagnostic tests for infants presenting with putative gastroesophageal reflux–related symptoms is contributing to the global expansion of empirical use of PPI in infants 0 to 6 months of age. This is despite the prevalence of so-called physiological reflux in this age group and the paucity of clear evidence-based guidance on appropriate dosing levels to achieve normalisation of acid exposure and clinical efficacy for reflux-related symptoms. Our study addresses the former with respect to the drug omeprazole; however, other PPIs need to be similarly tested. There is an urgent need to address the latter issue of clinical efficacy by way of randomised controlled trials. These trials must link PPI therapy with symptomatic improvement in patients specifically selected based on symptomatic, rather than pH-based, criteria. We would encourage all of those working in this field to take up this important challenge.

Efficacy of Conservative Therapy as Taught in the Primary Care Setting for Symptoms Suggesting Infant Gastroesophageal Reflux

To determine the efficacy of non-pharmacologic conservative therapy for infant gastroesophageal reflux disease (GERD). Consenting parents of the first 50 screened infants who met inclusion/exclusion criteria including abnormal (>16/42) scores on the Infant Gastroesophageal Reflux Questionnaire-Revised (I-GERQ-R; n = 40) were taught conservative therapy measures by each site's study nurse: feeding modifications, positioning, and tobacco smoke avoidance. We compared I-GERQ-R scores and symptom response details before and 2 weeks after institution of these measures with 2-tail Wilcoxon signed ranks test in the 37 infants (age range, 4-43 weeks; median age, 13 weeks) who completed the run-in. The median initial and final scores were 23 (16-36) and 18 (7-34; P < .000001). The median score change was -5 (+6--16). Scores of 78% improved at all; 59% improved at least the threshold of 5 points; 24% became normal. Scores for individual symptoms related to regurgitation, crying, and arching improved significantly. Two weeks of conservative therapy measures taught in primary care improved 59% beyond the 5-point threshold and normalized 24% of infants with symptom severity diagnostic for GERD, as substantiated with a responsiveness-validated instrument.

Pediatric and adolescent GERD

Gastroesophageal reflux (GER) and GER disease (GERD) are common problems in children and adults. Most infants with GER achieve symptomatic resolution by 1 year of age and are not thought to develop GERD later in life; most adults tolerate intermittent symptoms of heart-burn and nerve develop complications of GERD. Recent data suggest that some children who have persistent GER in infancy may develop symptoms of reflux in preadolescence. Similarly, when symptoms of reflux begin after the age of 2 years, concerns are raised that these symptoms could be early manifestations of GERD later in childhood, adolescence, or as an adult. Identification of children and adolescents with GERD, who may become adults with GERD or experience complications of GERD, is a significant challenge for practitioners. Implementation of safe and effective therapies is essential for not only improving symptoms and quality of life but also preventing long-term complications of GERD in adulthood.

A Financial Analysis of Pediatric Laparoscopic Versus Open Fundoplication

Laparoscopic fundoplication (LF) is rapidly replacing open fundoplication (OF) for correcting symptomatic gastroesophageal reflux (GER) in infants and children. In this study, we compared various clinical and financial parameters to determine if one technique is superior. With Institutional Review Board approval, charts and charge data for 50 consecutive patients undergoing elective LF or OF were reviewed in 2003 and 2004 (n = 100). Clinical variables evaluated included gender, age, weight, length of stay (LOS), operating time (OT), and time to initial (IF) and full (FF) feedings. Financial charges that were reviewed included anesthesia, central supply and sterilization, equipment, operating suite, hospital room and board, pharmacy, and total charges. The groups were equally matched in relation to gender, age, and weight. The table below illustrates the statistically significant differences (P < 0.05) between the groups. Favoring LNF LOS (1.2 vs. 2.9 days) IF (7.3 vs. 27.9 hours) FF (21.8 vs. 42.9 hours) Equipment ($1,006 vs. $1,609) Hospital Room ($1,290 vs. $2,847) Pharmacy ($180 vs. $461), Favoring OF OT (77 vs. 91 minutes) Anesthesia ($389 vs. $475) Central Supply and Sterilization ($1,367 vs. $2,515) Operating Suite ($4,058 vs. $5,142) Total charges were similar (LF, $11,449; OF, $11,632). Interestingly, although there were statistical differences in every charge category, total charges for LF and OF did not differ significantly. Thus, traditionally higher expenses from longer OT for LF seem to be offset by financial benefits, such as shorter LOS, reduced discomfort as evidenced by lower narcotic charges, and earlier IF/FF.

Validation issues in questionnaires for diagnosis and monitoring of gastroesophageal reflux disease in children

Pediatric gastroesophageal reflux disease (GERD) is common in infants and children; diagnosis is often based on symptom presentation. This paper reviews psychometric characteristics and approaches to validation of currently available pediatric GERD questionnaires. Patient-reported outcomes allow disease and treatment to be characterized in meaningful ways to patients and clinicians. Outcome measures must demonstrate reliability and validity for use in practice and in clinical trials. Reliability assesses the consistency of measures, whereas validity examines whether the instrument measures what it is purported to measure. Development of questionnaires for use with children also requires consideration regarding the respondent. Measures of pediatric GERD symptoms include the Infant Gastroesophageal Reflux Questionnaire (GERQ), the GERQ-Revised, and the GERD Symptom Questionnaire. These measures have advantages and disadvantages with regard to feasibility, reliability, and validity. Questionnaires are lacking for children older than 4 years.

Effect of Omeprazole on Acid Gastroesophageal Reflux and Gastric Acidity in Preterm Infants With Pathological Acid Reflux

Proton pump inhibitor (PPI) therapy is increasingly being used to treat premature infants with gastroesophageal reflux disease (GERD); however, the efficacy of PPI on acid production in this population has yet to be assessed in this patient group. The aim of this study was to determine the effect of 0.7 mg/kg/d omeprazole on gastric acidity and acid gastroesophageal reflux in preterm infants with reflux symptoms and pathological acid reflux on 24-h pH probe. A randomized, double blind, placebo-controlled, crossover design trial of omeprazole therapy was performed in 10 preterm infants (34-40 weeks postmenstrual age). Infants were given omeprazole for 7 d and then placebo for 7 d in randomized order. Twenty-four-hour esophageal and gastric pH monitoring was performed on days 7 and 14 of the trial. Compared to placebo, omeprazole therapy significantly reduced gastric acidity (%time pH <4, 54% vs 14%, P < 0.0005), esophageal acid exposure (%time pH <4, 19% vs 5%, P < 0.01) and number of acid GER episodes (119 vs 60 episodes, P < 0.05). Omeprazole is effective in reducing esophageal acid exposure in premature infants with pathological acid reflux on 24-h pH probe; however, the far more complex issues of safety and efficacy have yet to be addressed.

Diurnal Variation in the Chemical Clearance of Acid Gastroesophageal Reflux in Infants

Clearance of acid gastroesophageal reflux is biphasic. During volume clearance, refluxed material is cleared from the esophagus by peristalsis, and during chemical clearance, acidified esophageal mucosa is neutralized by saliva and possibly secretions from the esophageal lumen. In this study, we examined the effects of feeding on the durations of volume clearance and chemical clearance. Combined pH/multichannel intraluminal impedance tracings from 12 symptomatic infants (median age, 20 weeks) were analyzed. Acid gastroesophageal reflux episodes having both volume clearance and chemical clearance components were grouped into 1 of 4 feeding cycle phases (feeding, first hour postprandial, second hour postprandial, and fasting). Mean duration of volume clearance and chemical clearance was 7.0 +/- 2.3 and 36.3 +/- 8.5 minutes (P = .001), respectively, per patient and 24.7 +/- 2.7 and 127.5 +/- 10.7 seconds (P < .0001), respectively, per episode. Whereas volume clearance did not change throughout the feeding cycle, chemical clearance was significantly prolonged during fasting (132.2 +/- 18.4 seconds) compared with feeding (13.5 +/- 4.1 seconds, P = .0046) and 1st postprandial (64.0 +/- 19.4 seconds, P = .0333). Statistical analysis failed to demonstrate a significant relationship between nadir pH and chemical clearance (P = .3104) or between chemical clearance and the interaction between nadir pH and feeding cycle. Chemical clearance is significantly prolonged during fasting in infants. Falling pH alone cannot explain declining chemical clearance efficiency during later postprandial periods. We speculate that inefficient chemical clearance during fasting is likely due to reduced efficiency of acid clearance mechanisms that could include salivation, swallowing, peristalsis, and/or intraluminal secretion.

Effect of cereal-thickened formula and upright positioning on regurgitation, gastric emptying, and weight gain in infants with regurgitation

Objective We compared the effect of cereal-thickened formula or postural therapy on regurgitation and gastroesophageal reflux, weight gain, and gastric emptying in infants. Methods We performed a prospective trial in exclusively formula-fed infants 2 to 6 mo of age presenting with regurgitation or vomiting at least three times a day. Infants were randomized into two groups; group A received cereal-thickened formula versus group B who were placed in a postprandial upright position for 90 min and evaluated over an 8-wk period. A 90-min technetium 99m milk scintigraphy was performed before and at the end of the intervention period. Results Thirty-one infants were included in group A and 32 in group B; at inclusion, there were no anthropometric differences between groups ( P = 0.813–0.955). After 4 and 8 wk, the difference in regurgitation frequency per day between groups A and B had become significant (at 4 wk, 2.39 ± 0.86 for group A versus 2.84 ± 0.81 for group B, P = 0.039; at 8 wk, 1.61 ± 0.76 for group A versus 2.38 ± 0.83 for group B, P < 0.001). The volume ingested per meal was not different between groups after 4 wk, although this parameter showed a larger intake in group A after 8 wk (156.8 ± 23.5 mL for group A versus 143.4 ± 25.1 mL for group B, P = 0.035), resulting in a significant difference in mean caloric intake. Gastric emptying after 8 wk showed no significant difference between groups A and B. Group A infants had significantly greater weight gain than did group B infants after 4 wk (636.2 ± 103.4 g for group A versus 577.4 ± 102.7 g for group B, P = 0.03) and 8 wk (1261.3 ± 131.4 g for group A versus 1121.4 ± 137.2 g for group B, P < 0.001). After 8 wk of intervention, the increase in length was significantly greater in group A than in group B (5.2 ± 0.6 cm for group A versus 4.7 ± 0.6 cm for group B, P = 0.032). Conclusion Cereal-thickened formula is significantly more efficacious than postural therapy in decreasing the frequency of regurgitation in regurgitating infants. Treatment of regurgitation with cereal-thickened formula results in an increased caloric intake (∼25%), related to increased gain in weight and length, in comparison with regular formula and positioning therapy.

Effect of an Amino Acid-based Milk—Neocate®—on Gastro-Oesophageal Reflux in Infants Assessed by Combined Intraluminal Impedance/pH

Cow's milk protein allergy-related gastro-oesophageal reflux (GOR) may be due to episodes of inappropriate lower oesophageal sphincter relaxation. The hypothetical physiological mechanism invoked to explain this involves a neurological consequence of the inflammatory infiltration induced from lamina propria vessels into the epithelial compartment. However, the efficacy of this approach has so examined with a physiologically-appropriate denominator to define the degree of GOR. We intend to conduct an investigation of the influence of Neocate® an amino acid-based milk, on GOR in infants by using a combined pH and intraluminal oesophageal impedance measurement. 11 infants (6 male, median age 151 days, range 75 to 345 days) bottle-fed with either expressed breast milk or formula milk, with symptoms clinically suggestive of GOR, underwent two 24-hour studies of intra-oesophageal 6 channel impedance and dual-channel pH monitoring before and 14 days after establishment on Neocate® amino acid formula. Impedance/ ...

EXPERIENCE WITH THE MULTICHANNEL INTRALUMINAL IMPEDANCE-pH MONITORING IN 160 PATIENTS EVALUATED FOR GASTROESOPHAGEAL REFLUX

Background: Since the late 80's we learned with the 24 hour phmetry that the number of acid episodes modified with age. Nowadays with the Multichannel Intraluminal Impedance (IMM) we want to know if the same occurs with non acid gastroesophageal events. Aim: To investigate the presence of acid or non-acid gastroesophageal reflux with the Multichannel Intraluminal Impedance (MII)-pH probe in patients with suspected gastroesophageal reflux (GER). To study the different behavior of GER in infants and in children. Methods: A prospective study was conducted between January 2005 to March 2006 in a hundred-sixty patients which were divided into two groups: Group I: 80 infants (52 boys, 28 girls) <2 years (X: 6.8 months-r1-20 months) and Group II: 80 children (45 boys, 35 girls) > 2 years (X: 6.9 years-r2-16 years). The study was performed during 24 hours with a Sleuth GER Monitoring Recorder with ZPN or ZIN S61CO1E catheter with 7 impedance sensors plus one pH detector at the distal end. Results: 7192 gastroesophageal episodes were seen by impedance, 4127 (57.34%) were acid, 3068 (42.65%) were non-acid. The pH probe detected 3590 acid episodes. In Group I: Total episodes 3993; acid 2064 (51.7%); non-acid 1929 (48.3%). In Group II: Total episodes 3199; acid 2060 (64.4%); non-acid 1139 (35.6%). The proximal channel was reached in 61.2% in GI and in 61.3% in GII. Analyzing these data with the two sample t test we observed no significant difference in the behavior of acid reflux between GI and GII. Instead there was a significant difference with non acid episodes with P < 0.0001 in infants respect to children. Conclusions: The 24-hour Multichannel Intraluminal Impedance-pH monitoring resulted a good method to evaluate non acid reflux and the height of the episodes. In infants almost half of the gastroesophageal reflux events are non acid which will not be detected by conventional pHmetry. More studies are necessary to improve our knowledge of this novel tool and to better understand the implications derived from it.

Twenty-Four-Hour Esophageal Impedance-pH Monitoring in Healthy Preterm Neonates: Rate and Characteristics of Acid, Weakly Acidic, and Weakly Alkaline Gastroesophageal Reflux

Twenty-Four-Hour Esophageal Impedance-pH Monitoring in Healthy Preterm Neonates: Rate and Characteristics of Acid, Weakly Acidic, and Weakly Alkaline Gastroesophageal Reflux