Gastroesophageal reflux and sudden infant death syndrome

The possible role of gastroesophageal reflux in the pathogenesis of the sudden infant death syndrome (SIDS) has not yet been clearly defined, although it does appear that infants with significant reflux are at greater risk of respiratory complications. A study was undertaken to characterize more precisely the histological features of esophageal mucosa taken from a series of infants who died of SIDS to determine the range of changes present. Full-length strips of mucosa were examined microscopically for reflux-related changes of basal layer hyperplasia, papillary elongation, and intraepithelial eosinophilia. Eight infants (21%) showed changes considered diagnostic of reflux esophagitis, 17 infants (45%) showed minor nondiagnostic changes, and 13 infants (34%) showed no histologic abnormalities. These findings demonstrate considerable morphological heterogeneity in a group of infants presenting with sudden and unexpected death. The absence of, or presence of only very minor, pathological alterations within the esophageal mucosae of 79% of infants suggests that reflux of a degree sufficient to cause diagnostic histologic changes is found in only a minority of infants presenting with SIDS.