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Esophageal pH monitoring data during chest physiotherapy
Y Vandenplas1, A Diericx, U Blecker
1Academisch Ziekenhuis Kinderen, Vrije Universiteit Brussel, Belgium.
Insights
Chest physiotherapy significantly increases gastroesophageal reflux (GER) episodes in infants. Researchers recommend performing this therapy only during fasting periods to minimize reflux occurrences.
Area of Science:
- Pediatrics
- Gastroenterology
- Pulmonology
Background:
- Gastroesophageal reflux (GER) is common in infants.
- The relationship between GER and respiratory disease (RD) is not fully understood.
- Chest physiotherapy is a common intervention for infants with respiratory issues.
Purpose of the Study:
- To investigate the effect of chest physiotherapy on GER incidence in infants.
- To determine if GER episodes increase during physiotherapy sessions.
- To provide recommendations for optimizing physiotherapy timing.
Main Methods:
- Esophageal pH monitoring was used in 63 infants (1-4 months old).
- Infants included those with chronic vomiting, healthy controls, and those with acute RD.
- GER episodes were compared during physiotherapy versus baseline periods.
Main Results:
- GER incidence was significantly higher during chest physiotherapy compared to fasting or non-physiotherapy periods (p < 0.001).
- This increase was observed across all infant groups studied.
- Abnormal GER data were found in 37 out of 63 infants.
Conclusions:
- Chest physiotherapy significantly exacerbates gastroesophageal reflux in infants.
- It is recommended to administer chest physiotherapy during infants' fasting periods.
- Further research is needed to clarify the link between GER and respiratory disease.
Abstract:
Sixty-three infants, aged from 1 to 4 months, were examined for gastroesophageal reflux (GER) using esophageal pH monitoring. Thirty were examined because of chronic vomiting, 21 were healthy controls examined for GER as part of a screening program for sudden infant death syndrome, and 12 had an acute respiratory disease (RD). The 24-h pH monitoring data were within normal ranges in 26 infants (20 controls, 2 babies with emesis, and 4 with RD). Data were abnormal in 37 infants (1 control, 28 infants with emesis, and 8 with RD). All babies were submitted during a fasting awake period to a 30-min chest physiotherapy session. In the three groups studied, the incidence of GER episodes detected by the pH probe was significantly higher during physiotherapy if compared (a) to the calculated mean incidence during a 30-min period of the 24-h investigation or (b) to the incidence during a fasting awake period such as that during which the physiotherapy was given (p less than 0.001; Wilcoxon rank-sum test). We conclude that chest physiotherapy significantly increases GER incidence. We therefore propose restricting chest physiotherapy to fasting periods. These data add to the confusion that already exists regarding the possible causal relationship between (acid) GER and respiratory disease.