Postural drainage and gastro-oesophageal reflux in infants with cystic fibrosis.
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.


OBJECTIVE
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).


METHODS
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.
Button
B M
BM
Department of Physiotherapy, Royal Children's Hospital, Melbourne.
Heine
R G
RG
Catto-Smith
A G
AG
Phelan
P D
PD
Olinsky
A
A
D003550:Cystic Fibrosis / Q000150:complications* / Q000534:rehabilitation; D015916:Drainage, Postural / Q000009:adverse effects*; D004947:Esophagus / Q000378:metabolism; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology*; D018475:Head-Down Tilt / Q000009:adverse effects; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D026741:Physical Therapy Modalities / Q000009:adverse effects*; D016037:Single-Blind Method