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Postcibal gastroesophageal reflux in children
Insights
Frequent gastroesophageal reflux (GER) after clear liquid meals is likely normal in children. Medical or surgical treatments effectively reduced GER beyond two hours post-meal.
Area of Science:
- Pediatric Gastroenterology
- Digestive Health
- Infant Nutrition
Background:
- The impact of feeding on childhood gastroesophageal reflux (GER) requires further clarification.
- Understanding GER patterns post-feeding is crucial for accurate diagnosis and management in children.
Purpose of the Study:
- To investigate the effects of different feedings (apple juice vs. milk-formula) on postprandial gastroesophageal reflux (GER) in children.
- To assess the influence of feeding type and body position on GER frequency and duration in both asymptomatic and symptomatic children.
Main Methods:
- Continuous distal esophageal pH monitoring was performed on 56 children (28 asymptomatic, 28 symptomatic) for 3 hours post-feeding.
- Children were fed either apple juice or milk-formula, and GER events were quantified.
- The effect of the upright position and medical/surgical interventions on GER was also evaluated.
Main Results:
- Frequent GER occurred for up to 2 hours after apple juice feedings in asymptomatic children, and longer in symptomatic children.
- Milk-formula feedings led to decreased esophageal acidity compared to apple juice for the initial 2 hours.
- Neither feeding type nor the upright position significantly reduced GER in asymptomatic children beyond 2 hours post-feeding.
- Nissen fundoplication effectively eliminated GER, correlating with an inability to burp or vomit post-surgery.
Conclusions:
- Frequent GER for up to 2 hours after clear liquid meals is likely a physiological response in children.
- Effective control of vomiting via medical or surgical therapy correlated with reduced GER beyond 2 hours post-meal.
- Surgical intervention, like Nissen fundoplication, can significantly reduce or eliminate GER episodes.
Abstract:
The effect of eating on childhood gastroesophageal reflux (GER) is unclear. Twenty-eight asymptomatic children and 28 children with symptoms of GER were fed apple juice or milk-formula and observed for 3 hr postcibal. Distal esophageal pH was monitored continuously during this interval and used to quantitate the frequency and duration of GER. A period of frequent GER occurred for up to 2 hr after apple juice feedings in asymptomatic children, whereas symptomatic patients had frequent GER for longer periods. Compared to apple juice feedings, milk-formula feedings resulted in a decreased esophageal acidity for the first 2 hr. However, the type of feeding did not affect GER seen in asymptomatic children more than 2 hr postcibal. The frequency and duration of postcibal GER were not reduced by the upright position in either group. Effective medical treatment of symptomatic children did not eliminate the frequent GER within 2 hr of apple juice feedings, whereas the Nissen fundoplication usually eliminated all GER. The absence of GER episodes following apple juice correlated with the inability of most children to burp or vomit following antireflux surgery. Therefore, frequent GER for up to 2 hr after clear liquid meals is probably physiologic in children. The effective control of vomiting by medical or surgical therapy correlated best with a decrease in GER more than 2 hr postcibal.