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[Gastroesophageal reflux and ventilation with continuous positive pressure. Experimental study]
I Eizaguirre1, P Aldazábal, W Weilin
1Servicio de Cirugía Pediátrica, Hospital NaSa de Aránzazu, San Sebastián.
Summary
Continuous positive airway pressure (CPAP) in neonatal distress may increase gastroesophageal reflux (GER) risk. CPAP use weakens the antireflux barrier and elevates the gastroesophageal pressure gradient in infants.
Area of Science:
- Physiology
- Neonatal Medicine
Context:
- Gastroesophageal reflux (GER) is common in infants requiring respiratory support.
- Neonatal distress often necessitates respiratory assistance, such as continuous positive airway pressure (CPAP).
Purpose:
- To investigate the impact of increasing CPAP levels on the lower esophageal sphincter (LES) and the antireflux barrier in a rat model.
- To assess changes in thoracic and abdominal pressures under varying CPAP conditions.
Summary:
- Studies in rats demonstrated that CPAP use progressively shortens the intra-abdominal length of the esophagus (LIASE), weakening the antireflux barrier.
- While LES pressure and length remained unchanged, increased transdiaphragmatic pressure gradients were observed with higher CPAP levels.
- These findings suggest CPAP may increase GER risk by compromising the antireflux barrier and augmenting the gastroesophageal pressure gradient.
Impact:
- The study suggests a potential mechanism by which CPAP may contribute to GER in neonates.
- Highlights the need for further investigation into the clinical implications of CPAP use on GER in infants.
- Provides a basis for exploring strategies to mitigate GER in infants receiving respiratory support.