title: Effects of pectin liquid on gastroesophageal reflux disease in children with cerebral palsy.
abstract: BACKGROUND
  The use of thickeners is a standard therapy for decreasing episodes of regurgitation or vomiting in infants. However, it remains to be investigated whether thickener is effective for vomiting and/or chronic respiratory symptoms in children with cerebral palsy.
  
  
  METHODS
  We enrolled 18 neurologically impaired children caused by cerebral palsy, with gastroesophageal reflux disease. In the first part of this study (pH monitoring), subjects were randomly allocated to two groups: fed with a high-pectin diet [enteral formula: pectin liquid = 2:1 (v/v)], or a low-pectin diet [enteral formula: pectin liquid = 3:1 (v/v)]. Two-channel esophageal pH monitoring was performed over 48 h. In the second part (clinical trial), subjects were fed a high- or low-pectin diet and non-pectin diet for 4 weeks in a crossover manner. Nurses recorded the feeding volume, number of episodes of vomiting, volume of gastric residue, episodes of cough and wheeze, frequency of using oxygen for dyspnea, and the day when the child could return to school. Cough and wheeze were recorded as a cough-score.
  
  
  RESULTS
  The median value for the % time pH < 4 at the lower and upper esophagus was significantly decreased with a high-pectin diet [9.2% (6.2-22.6) vs. 5.0% (3.1-13.1); P < 0.01, 3.8% (2.9-11.2) vs. 1.6% (0.9-8.9); P < 0.01 (interquartile range), non-pectin and high-pectin, respectively]. The number of reflux episodes per day and duration of longest reflux were decreased significantly with a high-pectin, but not with a low-pectin diet. The median number of episodes of vomiting decreased significantly with a high-pectin diet [2.5/week (1.0-5.0) vs. 1.0 (1.0-1.5), P < 0.05]. The median cough-score was significantly decreased by both concentrations of pectin [8.5/week (1.0-11.5) vs. 2.0/week (0.0-3.0), fed with a high-pectin diet; 7.0/week (1.0-14.5) vs. 1.0/w (0.0-5.0), fed with a low-pectin diet, P < 0.05].
  
  
  CONCLUSIONS
  Pectin liquid partially decreased gastroesophageal reflux as measured by eshophageal pH monitoring, and might improve vomiting and respiratory symptoms in children with cerebral palsy.
  
  
  BACKGROUND
  ISRCTN19787793.
authors.affiliation: Department of Pediatrics and Developmental Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan. rmiyazaw@med.gunma-u.ac.jp
authors.forename: Reiko
authors.initials: R
authors.lastname: Miyazawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tomomasa
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kaneko
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Arakawa
authors.forename: Nobuzo
authors.initials: N
authors.lastname: Shimizu
authors.forename: Akihiro
authors.initials: A
authors.lastname: Morikawa
mesh_terms: D000293:Adolescent; D000930:Antidiarrheals / Q000008:administration & dosage*; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D003371:Cough / Q000209:etiology / Q000517:prevention & control; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D004750:Enteral Nutrition; D004947:Esophagus / Q000503:physiopathology; D005260:Female; D005526:Food, Formulated; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D010368:Pectins / Q000008:administration & dosage*; D015995:Prevalence; D014839:Vomiting / Q000209:etiology / Q000517:prevention & control
chemical_list: D000930:Antidiarrheals; D010368:Pectins