Few infants with reflux-like symptoms actually have GERD
Only 10% of preterm and term infants with strong clinical suspicion for reflux actually had true GERD based on multichannel intraluminal impedance testing, according to the results of a retrospective study.
“In preterm and term infants with strong clinical suspicion for reflux, the prevalence of significant GER as detected by MII-pH is low. The majority of suspected clinical reflux behaviors (irritability, apnea, bradycardia and desaturation) do not correlate with reflux events in preterm and term infants,” Zubair H. Aghai, MD, professor, director of neonatology research at Thomas Jefferson University, and attending neonatologist with Nemours duPont Pediatrics at Jefferson Hospital, told Healio Gastroenterology.
Zubair H. Aghai
Aiming to correlate observed reflux-like behaviors to true reflux events confirmed by MII-pH, Aghai and colleagues assessed observed clinical behaviors in 40 preterm and 18 term infants who were being evaluated for suspected GER between October 2009 and January 2012 in the neonatal intensive care unit or pediatric floor at Thomas Jefferson University Hospital. They used symptom index, symptom sensitivity index and symptom association probability to correlate symptoms with reflux events.
Only six (10%) of the infants had an abnormal MII-pH study. The most common indications for MII-pH study were irritability (55%), bradycardia (35%), desaturations (31%) and cough (21%).
Overall, 755 acidic and 1,386 nonacidic reflux episodes and 953 clinical reflux behaviors were recorded. Only six (10.3%) had acid exposure greater than 20% or more than 4.2 reflux episodes per hour. Preterm and term infants showed similar GER incidence and patterns, and there were no significant differences in GER episodes and acid exposure in preterm infants fed orally or by nasogastric tube. The symptom association probability was abnormal in only 6 (19%) of infants with irritability, 1 (5%) with bradycardia and 5 (28%) with desaturation.
Although the data were not shown, the researchers noted “there were no significant differences in symptom association analysis in infants with and without acid suppression therapy [but] the number of infants on acid suppression was too small for this comparison.”
“The clinicians should consider performing MII-pH study in infants with persistent symptoms of GERD before initiating medical therapy or surgical intervention,” Aghai said. “In infants with no temporal relationship between symptoms and reflux episodes, other etiologies for reflux like behavior should be sought.” – by Adam Leitenberger
Disclosure: The researchers report no relevant financial disclosures.