Acid gastroesophageal reflux in symptomatic infants is primarily a function of classic 2-phase and pH-only acid reflux event types.
BACKGROUND
Combined esophageal pH monitoring (EPM) and multichannel intraluminal impedance (MII) reveal 4 unique acid gastroesophageal reflux (AGER) types in infants: classic 2-phase, single-phase, pH-only events (POEs), and re-reflux episodes. The extent to which different AGER event types contribute to AGER frequency, acid reflux exposure time (ARET), and the number of episodes lasting 5 minutes or longer, has never been reported. In this study, EPM/MII was used to assess AGER in symptomatic infants on the basis of these 4 AGER types.


METHODS
EPM/MII tracings from 12 symptomatic infants (<12 months old) were examined. Mean frequencies and durations of each AGER type, percentages of total ARET due to each AGER type, and percentages of different AGER types lasting 5 minutes or longer, were measured.


RESULTS
Of 926 total AGER events, 23.1%, 6.3%, 69.2%, and 1.5% were classic 2-phase, single-phase, POEs, and re-reflux episodes, respectively. In 20.2 hours of combined ARET, 52.3%, 2.3%, 42.4%, and 3.0% occurred during classic 2-phase, single-phase, POEs, and re-reflux episodes, respectively. Classic 2-phase and POE events were both more frequent than single-phase (P = 0.002 and P < 0.0001) and re-reflux (P = 0.002 and P < 0.0001) episodes, respectively. Increasing numbers of AGER episodes were strongly correlated with POEs (P = 0.0001). Of the 35 total AGER episodes that lasted 5 minutes or longer, 94% were classic 2-phase episodes or POEs (57% and 37%, respectively).


CONCLUSIONS
In symptomatic infants, total AGER episodes, total ARET, and AGER episodes lasting 5 minutes or longer are largely a function of classic 2-phase and pH-only AGER types.
Center for Advanced Research in Neuromuscular Gastrointestinal Disorders, Division of Gastroenterology, Hepatology, and Nutrition, 700 Children's Drive, Nationwide Children's Hospital, Columbus, OH 43205, USA. frederick.woodley@nationwidechildrens.org
Frederick W
FW
Woodley
John
J
Hayes
Hayat
H
Mousa
D017097:Electric Impedance; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000145:classification* / Q000503:physiopathology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012044:Regression Analysis; D012720:Severity of Illness Index