title: Acid and non-acid reflux during physiotherapy in young children with cystic fibrosis.
abstract: BACKGROUND
  Gastro-esophageal reflux (GOR) may contribute to lung disease in children with cystic fibrosis (CF). There is conflicting evidence regarding the effect of chest physiotherapy (CPT) in the head-down position on GOR. Furthermore, there is currently no evidence on the impact of physiotherapy on GOR as assessed by pH-multichannel intraluminal impedance (pH-MII).
  
  
  OBJECTIVE
  (1) To characterize GOR in young children with CF. (2) To determine whether the head-down position during physiotherapy exacerbates GOR.
  
  
  METHODS
  Children were studied using pH-MII monitoring over 24-hr, during which they received two 20-min sessions of CPT. One session was performed in "modified" drainage positions with no head-down tilt and the alternate session in "gravity-assisted" drainage positions, which included 20° head-down tilt.
  
  
  RESULTS
  Twenty children with CF (8 males), median age 12 months (range 8-34) were recruited. A total of 1,374 reflux episodes were detected in all children, of which 869 (63%) were acid and 505 (37%) were non-acid. Seventy-two percent of the episodes migrated proximally. During CPT, there was no significant difference between total number of reflux episodes in the modified or gravity-assisted positions, median [inter-quartile range (IQR)] 1 (0-2.5) compared to 1 (0.75-3) episode, respectively, P = 0.63. There was also no significant difference between the number of reflux episodes which migrated proximally, median (IQR) 1 (0-2) compared to 0 (0-2) episodes, respectively, P = 0.75.
  
  
  CONCLUSIONS
  In young children with CF, GOR is primarily acidic and proximal migration is common. Physiotherapy in the head-down position does not appear to exacerbate GOR. The impact of GOR on lung disease remains to be elucidated.
authors.affiliation: Sydney Children's Hospital, Sydney, Australia. University of New South Wales, Sydney, Australia. michael.doumit@sesiahs.health.nsw.gov.au
authors.forename: Michael
authors.initials: M
authors.lastname: Doumit
authors.forename: Usha
authors.initials: U
authors.lastname: Krishnan
authors.forename: Adam
authors.initials: A
authors.lastname: Jaffé
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Belessis
mesh_terms: D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000150:complications / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000503:physiopathology*; D018475:Head-Down Tilt / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D026741:Physical Therapy Modalities / Q000009:adverse effects*; D013909:Thorax