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Postural drainage and gastro-oesophageal reflux in infants with cystic fibrosis
B M Button1, R G Heine, A G Catto-Smith
1Department of Physiotherapy, Royal Children's Hospital, Melbourne.
Insights
Standard physiotherapy with head-down tilt significantly increases gastroesophageal reflux in infants with cystic fibrosis. Modified physiotherapy without head-down tilt does not affect reflux, offering a safer alternative for these patients.
Area of Science:
- Pediatrics
- Gastroenterology
- Pulmonology
Background:
- Gastroesophageal reflux is common in cystic fibrosis.
- Postural drainage may worsen reflux and aspiration risk.
- Pulmonary function can be further impaired by aspiration.
Purpose of the Study:
- To assess the impact of standard physiotherapy with head-down tilt (SPT) on gastroesophageal reflux.
- To compare SPT with modified physiotherapy without head-down tilt (MPT).
Main Methods:
- Twenty infants with cystic fibrosis (mean age 2.1 months) underwent 30-hour esophageal pH monitoring.
- Both SPT and MPT were administered over consecutive days in separate sessions.
Main Results:
- SPT significantly increased the number of reflux episodes per hour compared to MPT and baseline.
- Fractional reflux time was elevated during SPT compared to baseline, but not MPT.
- MPT showed no significant difference in reflux parameters compared to baseline.
Conclusions:
- Standard physiotherapy with head-down tilt exacerbates gastroesophageal reflux in infants with cystic fibrosis.
- Modified physiotherapy without head-down tilt is a safer alternative, not increasing reflux.
Unlabelled:
Gastro-oesophageal reflux is increased in cystic fibrosis and it is possible that postural drainage techniques may exacerbate reflux, potentially resulting in aspiration and further impairment of pulmonary function.
Aim:
To evaluate the effects of physiotherapy with head down tilt (standard physiotherapy, SPT) on gastroesophageal reflux and to compare this with physiotherapy without head down tilt (modified physiotherapy, MPT).
Method:
Twenty (mean age 2.1 months) infants with cystic fibrosis underwent 30 hour oesophageal pH monitoring during which SPT and MPT were carried out for two sessions each on consecutive days.
Results:
The number of reflux episodes per hour, but not their duration, was significantly increased during SPT compared with MPT (SPT 2.5 (0.4) v MPT 1.6 (0.3), p = 0.007) and to background (1.1 (0.)1, p = 0.0005). Fractional reflux time was also increased during SPT (11.7 (2.6)%) compared with background (6.9 (1.3)%) p = 0.03) but not compared with MPT (10.7 (2.7)%). There was no significant difference between MPT and background for number of reflux episodes, their duration, or fractional reflux time.
Conclusions:
SPT, but not MPT, was associated with a significant increase in gastro-oesophageal reflux in infants with cystic fibrosis.