title: Clinical predictors of pathological gastro-oesophageal reflux in infants with persistent distress.
abstract: BACKGROUND
  Gastro-oesophageal reflux (GOR) is common in infants with persistent crying. Empirical treatment with antireflux medications is common practice, although on clinical grounds it may be difficult to determine whether GOR is abnormal.
  
  
  OBJECTIVE
  To examine the diagnostic accuracy of clinical predictors of pathological GOR in infants with persistent crying.
  
  
  METHODS
  One hundred and fifty-one infants (82 male; median age 2.5 months, range 0.5-8.2 months) with persistent crying were prospectively studied. Crying and fussing were charted for 24 h, and parents completed a validated questionnaire on reflux symptoms. All infants underwent oesophageal 24-h pH monitoring.
  
  
  RESULTS
  Twenty-seven (17.9%) infants had pathological GOR with a fractional reflux time (FRT) >10%. There was no significant association between total crying duration per 24 and FRT (P = 0.84) or the number of reflux episodes (P = 0.68). Pathological GOR was more common in infants under 3 months, compared to older infants (P = 0.04). Feeding difficulties were significantly associated with pathological GOR (P = 0.02). Backarching was not increased in infants with GOR (P = 0.30). Pathological GOR was significantly associated with the frequency of regurgitation (P = 0.04), but not with vomitus volume (P = 0.62). Regurgitation more than 5 times daily was the most specific reflux symptom (specificity 70.9%), but was a poor predictor of pathological GOR (positive predictive value 22.2%). In the absence of frequent regurgitation or feeding difficulties, pathological GOR was unlikely (negative predictive value 87-90%).
  
  
  CONCLUSIONS
  Investigation and treatment of GOR in infants with persistent crying should be primarily directed at infants presenting with frequent regurgitation or feeding difficulties.
authors.affiliation: Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Australia. ralf.heine@rch.org.au
authors.forename: Ralf G
authors.initials: RG
authors.lastname: Heine
authors.forename: Brigid
authors.initials: B
authors.lastname: Jordan
authors.forename: Lionel
authors.initials: L
authors.lastname: Lubitz
authors.forename: Michele
authors.initials: M
authors.lastname: Meehan
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Catto-Smith
mesh_terms: D000367:Age Factors; D000704:Analysis of Variance; D001315:Australia; D001942:Breast Feeding; D002908:Chronic Disease; D003085:Colic / Q000150:complications; D003448:Crying / Q000502:physiology; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000503:physiopathology; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D041943:Infant Formula; D008297:Male; D008499:Medical Records; D011379:Prognosis; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013997:Time Factors