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Patterns of gastroesophageal reflux (GER) in patients with apparent life-threatening events
L J Newman1, J Russe, M S Glassman
1Department of Pediatrics, New York Medical College, Valhalla 10595.
Insights
Gastroesophageal reflux (GER) is common in infants with apparent life-threatening events (ALTE), often occurring during sleep. This reflux pattern differs from infants experiencing only vomiting.
Area of Science:
- Pediatric Gastroenterology
- Neonatal Medicine
- Sleep Medicine
Background:
- Gastroesophageal reflux (GER) is a common condition in infants.
- Apparent life-threatening events (ALTE) are concerning episodes in infants that require evaluation.
- The relationship between GER and ALTE is not fully understood, particularly regarding reflux patterns.
Purpose of the Study:
- To compare the incidence and temporal patterns of GER in infants with ALTE versus infants evaluated for persistent emesis.
- To investigate if GER patterns differ between infants experiencing ALTE and those with vomiting alone.
Main Methods:
- Utilized continuous 24-hour intraesophageal pH monitoring in two groups of infants: those with ALTE and those with persistent emesis.
- Compared GER characteristics, including incidence and timing (sleep vs. awake), between the two groups.
Main Results:
- The incidence of significant GER was similar between infants with ALTE and those with persistent emesis.
- Infants with ALTE showed a significantly higher incidence of sleep reflux (27%) compared to controls (0%).
- Absence of a vomiting history was noted in 46% of ALTE patients, despite significant GER.
Conclusions:
- Significant GER is prevalent in infants with ALTE.
- Infants with ALTE exhibit a distinct GER pattern, characterized by a higher incidence of sleep reflux.
- The findings suggest a potential link between GER and ALTE, possibly related to apneic episodes, warranting further investigation.
Abstract:
The incidence and temporal patterns of gastroesophageal reflux (GER) in infants presenting with an apparent life-threatening event (ALTE) was compared with GER characteristics of infants evaluated for persistent emesis, utilizing continuous 24 h intraesophageal pH monitoring. These data indicate that the incidence of significant GER was similar in both groups, despite the absence of a clinical vomiting history in 46% of ALTE patients. Furthermore, infants with ALTE demonstrate a significantly higher incidence of sleep reflux when compared with control infants presenting with vomiting alone (27 vs. 0%, p less than 0.001). Awake GER beyond the first two postprandial hours was not observed in either study group. Monitoring results, therefore, indicate that significant GER is common in infants with ALTE; and these infants manifest an apparently unique pattern of GER distinct from that observed in age-matched controls with GER alone. Possible relationships between GER in ALTE patients and the development/onset of apneic episodes are discussed.