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Correlation between gastric acid secretion and severity of acid reflux in children
Nicolas Kalach1, Abdul Monem Badran, Patrick Jaffray
1Department of Pediatrics, Hôpital Cochin-Saint Vincent de Paul, Paris, France.
Insights
Children with prolonged gastro-esophageal reflux (GER) often hyper-secrete gastric acid, indicating a need for anti-acid treatment. Higher acid output correlates with severe GER and esophagitis, justifying anti-secretory therapy.
Area of Science:
- Pediatric Gastroenterology
- Acid Secretion Physiology
- Reflux Disease Management
Background:
- Gastro-esophageal reflux (GER) is common in children, with prolonged cases (>15 months) requiring thorough investigation.
- Understanding the mechanism of GER, particularly gastric acid output, is crucial for effective treatment strategies.
- Previous studies have not systematically evaluated gastric acid secretion in relation to GER severity and esophagitis in pediatric populations.
Purpose of the Study:
- To systematically evaluate gastric acid output in children with long-lasting GER.
- To assess the relationship between gastric acid secretion, GER severity, and the presence of esophagitis.
- To determine the need for and guide anti-acid treatment in pediatric GER patients.
Main Methods:
- Ambulatory 24-hour esophageal pH-monitoring was performed in 30 children (20 males, 10 females; aged 7.5 ± 3.8 years) with prolonged GER.
- Gastric acid secretion was measured, including basal (BAO), maximal (MAO), and peak acid outputs (PAO) post-pentagastrin stimulation.
- Upper fiber-endoscopy was conducted in children with heartburn or abdominal pain; patients were categorized into moderate (Group A, n=12) and severe (Group B, n=18) GER groups.
Main Results:
- Children with severe GER (Group B) exhibited significantly higher BAO, MAO, and PAO compared to those with moderate GER (Group A).
- A significant correlation was found between esophageal pH monitoring results and both MAO and PAO (r=0.33, p=0.05 and r=0.37, p=0.04, respectively).
- Five children in Group B with grade III esophagitis showed significantly higher acid secretion (BAO, MAO, PAO) than other children in Group B and those in Group A.
Conclusions:
- Children experiencing long-lasting and severe GER demonstrate hyper-secretion of gastric acid.
- Individual variations in gastric acid secretion levels likely influence the requirement for acid-inhibiting medications.
- Anti-secretory treatment is clinically justified for children with persistent GER and elevated pH-metric reflux index.
Abstract:
The purpose of our study was to systematically evaluate gastric acid output in children with long-lasting gastro-esophageal reflux (GER) in order to assess its mechanism and the need for anti-acid treatment. The investigation was carried out in 20 males and 10 females, aged 7.5 +/- 3.8 years, with prolonged (>15 months) clinical manifestations of GER. All underwent routine ambulatory 24-h esophageal pH-monitoring and measurement of gastric acid secretion including gastric basal (BAO) (micromol/kg/h), maximal (MAO) and peak acid outputs (PAO) after pentagastrin (6 microg/kg sec) stimulation. Children with heartburn or abdominal pain underwent upper fiber-endoscopy. In group A (moderate GER, n=12), patients had a normal reflux index (pH<4 below 5.2% of total recording time) despite abnormal Euler and Byrne scoring (median 57, 95% confidence interval 53.5-73.4). In group B (severe GER, n=18, among whom 5 were with grade III esophagitis), reflux index was >5.2%. When considering all children, esophageal pH (%) was significantly correlated with MAO and PAO, r=0.33, p=0.05 and r=0.37, p=0.04, respectively. Children of group B exhibited significantly higher BAO (75, 53.96-137.81), MAO (468, 394.1-671.3) and PAO (617, 518.8-782.3) than those of group A, BAO (27, 10.8-38.5), MAO (266, 243.2-348.2) and PAO (387, 322.5-452.7), p<0.05). The five children of group B with severe esophagitis exhibited significantly higher BAO, MAO and PAO than the other 13 children from the same group and those of group A, p<0.05. Children with long-lasting and severe GER hyper-secrete gastric acid. Individual variations in gastric acid secretion probably account for variations in gastric acid inhibitor requirements. Anti-secretory treatment is justified in children with long-lasting GER and high pH-metric reflux index.