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 18 February 2018

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News

GERD in infants: how much is predictable?

Histology and pH study show poor correlation in infants with gastroesophageal reflux disease however, regurgitation and crying show some correlation, reports February's Journal of Pediatric Gastroenterology and Nutrition.

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Symptoms of gastroesophageal reflux disease (GERD) are common in infants.

It is often difficult to discriminate between physiological and pathologic gastresophageal reflux, although this discrimination is essential to determine which infants to evaluate and treat.

Dr Silvia and colleagues undertook a study in order to identify the prevalence of reflux symptoms in infants.

In addition, the research team aimed to evaluate the predictive value of a questionnaire and the correlation between pH study, histology and clinical score.

The researchers asked parents of 100 unselected infants visiting the well-baby clinic and 100 infants suspected of having gastroesophageal reflux disease to fill in a 35-item questionnaire.

The researchers applied a validated score, the Orenstein I-GERQ, for selected questions.

The research team undertook prolonged esophageal pH monitoring of all infants suspected of having gastroesophageal reflux disease.

Endoscopists performed upper gastrointestinal tract endoscopy with esophageal biopsy on a further 44 or 100.

38% of infants with a pathologic pH study had a normal esophageal biopsy
Journal of Pediatric Gastroenterology and Nutrition

Parents of infants with suspected gastroesophageal reflux disease reported significantly more regurgitation (68% vs 45%) and crying (51% vs 20%) compared with the parents of healthy infants.

The researchers noted in a pathologic pH study in 21 of 100 infants and this was significantly associated only with pneumonia, apnea with fussing, defecation less than once a day and constipation.

The research team found esophagitis in 17 of 44 and no 1 question was significantly predictive.

38% of infants with a pathologic pH study had a normal esophageal biopsy and 53% of infants with histologic esophagitis had a normal pH study.

The team noted that discordance between pH study and biopsies occurred in 14 of 44 patients.

The Orenstein I-GERQ cut-off score failed to identify 8 of 31 infants with gastroesophageal reflux disease.

Dr Silvia commented, "Clinical symptoms, histology and pH study show poor correlation in infants."

"Clinical symptoms such as regurgitation and crying are less frequent in unselected infants than in infants suspected of gastroesophageal reflux disease."

Dr Silvia pointed out, "However, questionnaires are poorly predictive for the severity of gastroesophageal reflux disease, as they do not correlate with esophageal acid exposure as measured by pH-metry and with esophagitis as evaluated by histology of esophageal biopsies."

Journal of Pediatric Gastroenterology and Nutrition; 2005: 40 (2): 210-15
11 February 2005

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