Natural history of infant reflux esophagitis: symptoms and morphometric histology during one year without pharmacotherapy.
OBJECTIVE
To determine the natural history of infant gastroesophageal reflux disease (GERD) with esophagitis, we periodically analyzed symptoms and biopsies during 1 yr in 19 infants randomly assigned to placebo in a pharmacotherapy study.


METHODS
One hundred infants who were referred during 1994-1999 for GERD, were unresponsive to 2-wk life-style measures, and manifested morphometric reflux esophagitis, were assigned at random to one of four treatment arms. This analysis examines the 19 (ages 2.8-6.0 months) assigned to placebo who returned for initial follow-up. SYMPTOMS and esophageal biopsy were assessed at baseline and 2, 4, 6, and 12 months. At any visit with both symptoms and biopsy unimproved, infants were "rescued" to open label active drug.


RESULTS
By 12 months, 10/19 completed without rescue; the 9 others withdrew (3) or required pharmacotherapy (6).


METHODS
Among the 10 nonrescued completers, parents' global score rated 9 "completely well," and 1 "improved." Comparing 12-month symptoms to baseline symptoms in the 10 completers, fewer reported regurgitation >3/day, >1 Tbsp, or that was uncomfortable; crying >1 h/d, or during or after feeds; or arching spells or abnormal hiccups (p < 0.05, chi(2)). Biopsy: None of the 10 ever had normal biopsies (basal cell layer <25% and papillary height <53% of epithelial thickness). One had normal papillary height, but abnormal basal thickness. Five others had normal basal thickness, but all five of them had abnormal papillary height.


CONCLUSIONS
Although symptoms improved in more than half of the infants with reflux esophagitis followed longitudinally for 1 yr without pharmacotherapy, histology remained abnormal.
Pediatric Gastroenterology, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, One Children's Place, Pittsburgh, PA 15213-2583, USA.
Susan R
SR
Orenstein
Theresa M
TM
Shalaby
Sheryl F
SF
Kelsey
Eric
E
Frankel
D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001706:Biopsy; D003131:Combined Modality Therapy; D004942:Esophagitis, Peptic / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D004947:Esophagus / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005769:Gastrointestinal Motility / Q000187:drug effects; D006633:Histamine Antagonists / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008019:Life Style; D008297:Male; D019370:Observation; D011970:Receptors, Histamine H2 / Q000187:drug effects*; D012075:Remission, Spontaneous
D000897:Anti-Ulcer Agents; D006633:Histamine Antagonists; D011970:Receptors, Histamine H2