Proton pump inhibitors for reflux therapy in infants: effectiveness determined by impedance pH monitoring
Related Experiment Video
Updated: May 3, 2026
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Christoph Castellani1, Andrea Huber-Zeyringer, Gerhard Bachmaier
1Department of Pediatric and Adolescent Surgery, Medical University Graz, Auenbruggerplatz 34, 8036, Graz, Austria, christoph.castellani@medunigraz.at.
Insights
Proton pump inhibitors (PPIs) reduced acid reflux in infants with GERD but did not significantly improve vomiting or respiratory symptoms. PPIs were most effective for pain-related symptoms, suggesting targeted use.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Motility Disorders
Background:
- Gastroesophageal reflux disease (GERD) is common in infants.
- Proton pump inhibitors (PPIs) are frequently used to manage GERD symptoms.
Purpose of the Study:
- To evaluate the efficacy of PPIs in predominantly milk-fed infants with GERD symptoms.
- To assess the impact of PPIs on 24-h pH-multichannel intraluminal impedance (24-h pH-MII) parameters and clinical symptoms.
Main Methods:
- Ten infants underwent 24-h pH-MII before and during PPI treatment.
- Acid exposure time, reflux events (acidic/non-acidic), and bolus exposure time were measured.
- Clinical symptoms were quantified using the Reflux Symptom Index (RSI) and Symptom Severity Index (SSI).
Main Results:
- PPIs significantly reduced acidic refluxes, total acid exposure, and acidic bolus exposure.
- Non-acidic bolus exposure time significantly increased, while total reflux numbers remained unchanged.
- Pain-related symptoms (RSI, SSI) improved, but respiratory symptoms and vomiting showed no significant change.
Conclusions:
- PPIs are effective in improving pain-related symptoms in infants with GERD.
- The increase in non-acidic refluxes may explain persistent symptoms despite adequate PPI dosage.
- PPI therapy should be reserved for pain-related GERD symptoms, with limited benefit for vomiting or respiratory issues.
Purpose:
To evaluate the influence of proton pump inhibitors (PPI) in predominantly milk-fed infants with symptoms of GERD by 24-h pH-multichannel intraluminal impedance (24-h pH-MII).
Methods:
Ten infants (8 males and 2 females) with a mean gestational age of 39 weeks (28-40) were included. 24-h pH-MII was performed before prescription and during intake of PPI. Total acid exposure time, bolus exposure time (acidic/non-acidic/total) and the number of refluxes (acidic/non-acidic/total) were determined. Clinical symptoms were recorded and used to calculate the Reflux Symptom Index (RSI) and the Symptom Severity Index (SSI).
Results:
There was a significant decrease in the number of acidic refluxes, total acid exposure and acidic bolus exposure time. However, this went along with a significant increase in non-acidic bolus exposure time. The total number of refluxes and the total bolus exposure time remained unchanged. Under PPI, a decrease of SSI and RSI for pain-related symptoms could be observed. For respiratory symptoms and vomiting however no significant changes could be demonstrated.
Conclusions:
Under PPI, an improvement of pain-related symptoms could be shown. The decrease of acid exposure went along with an increase of non-acidic refluxes resulting in almost constant total reflux numbers. This finding is interpreted as main reason for some persisting symptoms despite adequate PPI dosage. Concluding from our data PPI therapy should only be indicated in case of pain, but has no effect in case of vomiting or recurrent respiratory symptoms.
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