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Alkaline gastroesophageal reflux in infancy
1Academisch Ziekenhuis Kinderen, Vrije Universiteit Brussel, Belgium.
Summary
Alkaline reflux in infants is rare but can cause esophagitis. New pH monitoring ranges may help diagnose this condition, with higher pH levels linked to esophagitis in some infants.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Motility Disorders
- Esophageal pH Monitoring
Background:
- Alkaline gastroesophageal reflux is a rare condition implicated in infant esophagitis.
- Currently, no universally accepted diagnostic method exists for routine alkaline reflux diagnosis.
- Establishing normal pH ranges is crucial for identifying abnormal reflux in infants.
Purpose of the Study:
- To propose and evaluate normal ranges for alkaline reflux episodes (pH > 7.0 and pH > 7.5) in infants.
- To assess the correlation between elevated alkaline reflux parameters and esophagitis.
- To validate proposed pH monitoring cut-offs in a prospective cohort of symptomatic children.
Main Methods:
- Infant pH monitoring to determine time percentage and episode counts with pH > 7.0 and pH > 7.5.
- Comparison of pH data between asymptomatic and symptomatic infant groups.
- Prospective study involving 200 symptomatic children (vomiting, crying, respiratory issues) to evaluate proposed ranges.
Main Results:
- Asymptomatic infants (n=83) had mean pH > 7.0 for 1.3% of the time (10.4 episodes/24h).
- Symptomatic infants (n=60) had significantly lower mean pH > 7.0 (0.15% time, 2.8 episodes/24h).
- Three of four infants exceeding proposed pH > 7.0 limits showed histological esophagitis.
Conclusions:
- Proposed pH monitoring ranges for alkaline reflux may aid in diagnosing infant esophagitis.
- Elevated alkaline reflux episodes (pH > 7.0) warrant further investigation, including esophagoscopy.
- Further validation is needed to refine diagnostic criteria for alkaline reflux in pediatric populations.