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Published on: August 27, 2021
Effect of anesthesia on gastroesophageal reflux in children: a study using BRAVO wireless pH study measurements
L Rodriguez1, A Morley-Fletcher2, A Souza3
1Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Insights
Anesthesia significantly increases gastroesophageal reflux (GER) in children, particularly in the first hour after placement. This effect may alter pH study interpretations, highlighting the need to consider anesthesia
Area of Science:
- Pediatric Gastroenterology
- Anesthesiology
- Diagnostic Studies
Background:
- Adult studies indicate conscious sedation increases gastroesophageal reflux (GER).
- The impact of anesthesia on GER in pediatric populations remains unclear.
- This study investigates anesthesia's effect on GER and pH study interpretation in children.
Purpose of the Study:
- To assess the influence of anesthesia on gastroesophageal reflux (GER) parameters in children.
- To evaluate how anesthesia affects the interpretation of pH monitoring studies.
- To determine the duration of anesthesia's impact on GER in pediatric patients.
Main Methods:
- Included children undergoing BRAVO wireless pH capsule placement under anesthesia (>36h study duration).
- Analyzed pH parameters (reflux episodes, duration, time pH <4) in 1, 2, 6-h, and total blocks.
- Evaluated interpretation changes after excluding the first 1-h and 2-h blocks.
Main Results:
- A significant increase in GER parameters was observed in the first hour post-anesthesia.
- No significant overall change in study interpretation (normal vs. abnormal) was found.
- Excluding the initial 2 hours altered interpretation from abnormal to normal in 5% of patients.
Conclusions:
- Anesthesia demonstrably increases GER parameters in children, primarily within the first 6 hours.
- The initial hours post-anesthesia may lead to misinterpretation of GER study results.
- Consideration of anesthesia's impact is crucial for accurate pediatric GER diagnosis.
Background:
Adult studies suggest conscious sedation increases gastroesophageal reflux (GER), but the role of anesthesia on GER in children is unclear. Our aim was to study the anesthesia effects on GER and pH study interpretation in children.
Methods:
Children undergoing BRAVO wireless pH capsule placement under anesthesia and study duration >36 h were included. We evaluated the pH parameters (number of reflux episodes >5 min, duration of longest reflux episode, time pH <4 and fraction time pH <4) at 1, 2, 6-h and total study duration blocks using 2 cutoff values (5.3% and 6%) for the worst day, average of both days, and 1st day alone. We compared time blocks to evaluate the effect of anesthesia on GER and the proportions of studies changing interpretation after excluding the 1st hour and 1st 2-h blocks to evaluate anesthesia effect on study interpretation.
Key Results:
A total of 150 children were included. We found a significant increase on the pH parameters in the 1st hour compared to subsequent block times suggesting an effect of anesthesia on GER. We found no significant change in the proportion of studies interpreted as normal vs abnormal, however, excluding the initial 2 h of the study would change the study interpretation from abnormal to normal in up to 5% of patients.
Conclusions & Inferences:
We found an effect of anesthesia increasing the GER parameters mainly in the 1st hour and up to the first 6 h of the study that may result in a change in the study interpretation.
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