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Updated: Aug 10, 2026
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Natural history of infant reflux esophagitis: symptoms and morphometric histology during one year without
Susan R Orenstein1, Theresa M Shalaby, Sheryl F Kelsey
1Pediatric Gastroenterology, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, One Children's Place, Pittsburgh, PA 15213-2583, USA.
Insights
Infant gastroesophageal reflux disease (GERD) symptoms improved in over half of infants without medication over one year. However, esophageal biopsies showed persistent histological abnormalities, indicating ongoing inflammation.
Area of Science:
- Pediatrics
- Gastroenterology
- Clinical Medicine
Background:
- Infant gastroesophageal reflux disease (GERD) is common, often managed with lifestyle changes and pharmacotherapy.
- Esophagitis, a complication of GERD, requires careful monitoring of both symptoms and histological changes.
- The natural history of infant GERD with esophagitis without pharmacotherapy is not fully understood.
Purpose of the Study:
- To determine the natural history of infant GERD with esophagitis.
- To analyze symptom and biopsy changes over one year in infants receiving a placebo.
- To assess the long-term impact of GERD on esophageal histology in infants.
Main Methods:
- A cohort of 19 infants (ages 2.8-6.0 months) with GERD and esophagitis were assigned to a placebo group.
- Symptoms and esophageal biopsies were assessed at baseline and at 2, 4, 6, and 12 months.
- Infants were transitioned to active medication if symptoms and biopsy results remained unimproved ('rescued').
Main Results:
- Ten out of 19 infants completed the 12-month follow-up without requiring pharmacotherapy.
- Significant symptom improvement was reported by parents in 90% of the completers.
- Despite symptom improvement, none of the 10 completers showed normal esophageal biopsy results at 12 months.
Conclusions:
- Symptomatic improvement in infant GERD with esophagitis can occur without pharmacotherapy over one year.
- Histological evidence of esophagitis persists even when symptoms improve.
- Longitudinal monitoring including biopsy is crucial for managing infant GERD with esophagitis.
Objectives:
To determine the natural history of infant gastroesophageal reflux disease (GERD) with esophagitis, we periodically analyzed symptoms and biopsies during 1 yr in 19 infants randomly assigned to placebo in a pharmacotherapy study.
Methods:
One hundred infants who were referred during 1994-1999 for GERD, were unresponsive to 2-wk life-style measures, and manifested morphometric reflux esophagitis, were assigned at random to one of four treatment arms. This analysis examines the 19 (ages 2.8-6.0 months) assigned to placebo who returned for initial follow-up. SYMPTOMS and esophageal biopsy were assessed at baseline and 2, 4, 6, and 12 months. At any visit with both symptoms and biopsy unimproved, infants were "rescued" to open label active drug.
Results:
By 12 months, 10/19 completed without rescue; the 9 others withdrew (3) or required pharmacotherapy (6).
Symptoms:
Among the 10 nonrescued completers, parents' global score rated 9 "completely well," and 1 "improved." Comparing 12-month symptoms to baseline symptoms in the 10 completers, fewer reported regurgitation >3/day, >1 Tbsp, or that was uncomfortable; crying >1 h/d, or during or after feeds; or arching spells or abnormal hiccups (p < 0.05, chi(2)). Biopsy: None of the 10 ever had normal biopsies (basal cell layer <25% and papillary height <53% of epithelial thickness). One had normal papillary height, but abnormal basal thickness. Five others had normal basal thickness, but all five of them had abnormal papillary height.
Conclusion:
Although symptoms improved in more than half of the infants with reflux esophagitis followed longitudinally for 1 yr without pharmacotherapy, histology remained abnormal.
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