title: Small volumes of feed can trigger transient lower esophageal sphincter relaxation and gastroesophageal reflux in the right lateral position in infants.
abstract: OBJECTIVE
  To investigate the threshold amount of constantly infused feed needed to trigger lower esophageal sphincter relaxation (TLESR) in the right lateral position (RLP) and left lateral position (LLP).
  
  
  METHODS
  Eight healthy infants (3 male; gestational age: 32.9 +/- 2.4 weeks; corrected age: 36.1 +/- 1.3 weeks) were studied using an esophageal impedance-manometry catheter incorporating an intragastric infusion port. After tube placement, infants were randomly positioned in RLP or LLP. They were then tube-fed their normal feed (62.5 [40 to 75] mL) at an infusion rate of 160 mL/h. Recordings were made during the feed and 15 minutes thereafter. The study was repeated with the infant in the opposite position.
  
  
  RESULTS
  More TLESRs were triggered in the RLP compared with LLP (4.0 [3.0 to 6.0] vs 2.5 [1.0 to 3.0], P = .027). First TLESR occurred at a significantly lower infused volume in RLP compared with LLP (10.6 +/- 9.4 vs 21.0 +/- 4.9 mL, P = .006). The percentage of feed infused at time of first TLESR was significantly lower in RLP compared with LLP (17.6% +/- 15.5% vs 35.4% +/- 8.02%, P = .005).
  
  
  CONCLUSIONS
  In the RLP, TLESRs and gastroesophageal reflux are triggered at volumes unlikely to induce gastric distension.
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands. m.p.vanwijk@amc.nl
authors.forename: Michiel P
authors.initials: MP
authors.lastname: van Wijk
authors.forename: Marc A
authors.initials: MA
authors.lastname: Benninga
authors.forename: Geoffrey P
authors.initials: GP
authors.lastname: Davidson
authors.forename: Ross
authors.initials: R
authors.lastname: Haslam
authors.forename: Taher I
authors.initials: TI
authors.lastname: Omari
mesh_terms: D017097:Electric Impedance; D004750:Enteral Nutrition; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000503:physiopathology*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000503:physiopathology*; D008297:Male; D008365:Manometry; D009126:Muscle Relaxation; D011187:Posture