Esophagitis and modified Bernstein tests in infants with apparent life-threatening events

The current study was undertaken to determine the prevalence of abnormal intraesophageal pH monitoring, esophagitis, and oxygen desaturation after experimental esophageal acidification (modified Bernstein test) in patients with apparent life-threatening events (ALTEs).

Fifty patients admitted to the hospital with ALTEs were evaluated. Patients underwent 24-hour intraesophageal pH monitoring, esophageal suction biopsies, and modified Bernstein tests to document oxygen desaturation during experimental esophageal acidification.

Abnormal pH monitoring was present in 82%, esophagitis in 16%, and oxygen desaturation of at least 5% with experimental esophageal acidification in 22% of the patients. Esophagitis was present in only 3 of 11 patients with oxygen desaturation, which was not different from those patients without oxygen desaturation. Clinical history was not predictive of oxygen desaturation during experimental acidification except that patients with a history of an ALTE while awake were more likely to demonstrate oxygen desaturation with acid.

We conclude that 1) the prevalence of oxygen desaturation with experimental acidification in infants with ALTEs is significant and warrants further evaluation; 2) esophagitis is not a necessary predisposing condition to esophageal acid sensitivity in infants with ALTEs; and 3) ALTEs while awake are frequently associated with a positive modified Bernstein test.