Upper GI function in sleeping infants.
In using the intraesophageal pH probe, considerable information has been gathered surrounding upper GI function during sleep in infants. However, there is considerable variability in the position of probe placement and the establishment of control values. Data as to whether the feedings are acidified, as well as position, has varied from study to study. Despite these shortcomings, one can conclude the following: asymptomatic episodes of gastroesophageal reflux occur throughout the 24-h period, but with considerably less frequency and duration during the sleep period. This is true for adults as well as for infant control subjects and the sleep reflux scores appear to be slightly higher in infants than in adults; intraesophageal pH monitoring is helpful in establishing a temporal relationship between pulmonary symptoms and episodes of gastroesophageal reflux, during sleep as well as awake periods. This relationship has been established in a very limited number of patients who have subsequently responded to both medical and surgical management; the mechanisms for gastroesophageal reflux in infants appear to be predominantly not related to a weak lower esophageal sphincter pressure but may occur as a complex result of "inappropriate" relaxation of the lower esophageal sphincter and/or increased intra-abdominal pressure overcoming the lower esophageal sphincter pressure barrier. Further investigation as to mechanisms responsible for physiologic as well as pathologic reflux need to be pursued; standardization of the intraesophageal pH monitoring test has to be achieved and efforts must be made to obtain the best control values possible while following ethical guidelines for clinical trials for pediatrics. This would include the standardization of the probe position, meals, scoring system, patient position, and intervals to be used in monitoring.
D000328:Adult; D004943:Esophagogastric Junction / Q000601:surgery; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D007231:Infant, Newborn; D011015:Pneumonia, Aspiration / Q000209:etiology*; D011187:Posture; D012890:Sleep / Q000502:physiology; D013270:Stomach / Q000601:surgery