title: The impact of reflux burden on Pseudomonas positivity in children with cystic fibrosis.
abstract: OBJECTIVE
  Nonacid gastroesophageal reflux (GER), particularly in patients taking acid suppression, has been implicated as a cause of respiratory infections. We hypothesize that children with cystic fibrosis (CF) and a higher nonacid reflux burden have greater rates of Pseudomonas aeruginosa (Pa) infection than patients with a lower reflux burden.
  
  
  METHODS
  We reviewed the multichannel intraluminal impedance (pH-MII) tracings of 35 patients with CF between 2003 and 2010. We compared the reflux profiles between those patients who were Pa positive and Pa negative.
  
  
  RESULTS
  The mean age was 13.5 ± 5.8 years. Twenty-seven patients (76%) were Pa positive. Ninety seven percent of patients were taking proton pump inhibitors during pH-MII testing. The mean percentage of time pH was <4 was 8.5 ± 12%. Pa patients had a significantly higher total, acid and proximal nonacid reflux burden (P < 0.009). There was a negative correlation between nonacid reflux burden and FEV1 (r = -0.397, P = 0.03) and between total number of reflux events and FEV1 (r = -0.474, P = 0.009). After adjusting for age and FEV1, total reflux burden remains significantly associated with Pa positivity (P = 0.055).
  
  
  CONCLUSIONS
  Increased reflux burden may predispose patients to Pa infection and worse lung function.
authors.affiliation: Division of Respiratory Diseases, Children's Hospital Boston, Boston, Massachusetts, USA.
authors.forename: Kara
authors.initials: K
authors.lastname: Palm
authors.forename: Gregory
authors.initials: G
authors.lastname: Sawicki
authors.forename: Rachel
authors.initials: R
authors.lastname: Rosen
mesh_terms: D000293:Adolescent; D002648:Child; D003550:Cystic Fibrosis / Q000150:complications*; D050782:Esophageal pH Monitoring; D005541:Forced Expiratory Volume; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008168:Lung / Q000503:physiopathology; D008171:Lung Diseases / Q000382:microbiology; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011552:Pseudomonas Infections / Q000150:complications*; D011550:Pseudomonas aeruginosa; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors