title: Correlation between gastric acid secretion and severity of acid reflux in children.
abstract: The purpose of our study was to systematically evaluate gastric acid output in children with long-lasting gastro-esophageal reflux (GER) in order to assess its mechanism and the need for anti-acid treatment. The investigation was carried out in 20 males and 10 females, aged 7.5 +/- 3.8 years, with prolonged (>15 months) clinical manifestations of GER. All underwent routine ambulatory 24-h esophageal pH-monitoring and measurement of gastric acid secretion including gastric basal (BAO) (micromol/kg/h), maximal (MAO) and peak acid outputs (PAO) after pentagastrin (6 microg/kg sec) stimulation. Children with heartburn or abdominal pain underwent upper fiber-endoscopy. In group A (moderate GER, n=12), patients had a normal reflux index (pH<4 below 5.2% of total recording time) despite abnormal Euler and Byrne scoring (median 57, 95% confidence interval 53.5-73.4). In group B (severe GER, n=18, among whom 5 were with grade III esophagitis), reflux index was >5.2%. When considering all children, esophageal pH (%) was significantly correlated with MAO and PAO, r=0.33, p=0.05 and r=0.37, p=0.04, respectively. Children of group B exhibited significantly higher BAO (75, 53.96-137.81), MAO (468, 394.1-671.3) and PAO (617, 518.8-782.3) than those of group A, BAO (27, 10.8-38.5), MAO (266, 243.2-348.2) and PAO (387, 322.5-452.7), p<0.05). The five children of group B with severe esophagitis exhibited significantly higher BAO, MAO and PAO than the other 13 children from the same group and those of group A, p<0.05. Children with long-lasting and severe GER hyper-secrete gastric acid. Individual variations in gastric acid secretion probably account for variations in gastric acid inhibitor requirements. Anti-secretory treatment is justified in children with long-lasting GER and high pH-metric reflux index.
authors.affiliation: Department of Pediatrics, Hôpital Cochin-Saint Vincent de Paul, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Kalach
authors.forename: Abdul Monem
authors.initials: AM
authors.lastname: Badran
authors.forename: Patrick
authors.initials: P
authors.lastname: Jaffray
authors.forename: Florence
authors.initials: F
authors.lastname: Campeotto
authors.forename: Pierre Henri
authors.initials: PH
authors.lastname: Benhamou
authors.forename: Christophe
authors.initials: C
authors.lastname: Dupont
mesh_terms: D000293:Adolescent; D000863:Antacids / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D005260:Female; D005744:Gastric Acid / Q000378:metabolism*; D005764:Gastroesophageal Reflux / Q000145:classification* / Q000188:drug therapy; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D012720:Severity of Illness Index
chemical_list: D000863:Antacids