Effect of anesthesia on gastroesophageal reflux in children: a study using BRAVO wireless pH study measurements.
BACKGROUND
Adult studies suggest conscious sedation increases gastroesophageal reflux (GER), but the role of anesthesia on GER in children is unclear. Our aim was to study the anesthesia effects on GER and pH study interpretation in children.


METHODS
Children undergoing BRAVO wireless pH capsule placement under anesthesia and study duration >36 h were included. We evaluated the pH parameters (number of reflux episodes >5 min, duration of longest reflux episode, time pH <4 and fraction time pH <4) at 1, 2, 6-h and total study duration blocks using 2 cutoff values (5.3% and 6%) for the worst day, average of both days, and 1st day alone. We compared time blocks to evaluate the effect of anesthesia on GER and the proportions of studies changing interpretation after excluding the 1st hour and 1st 2-h blocks to evaluate anesthesia effect on study interpretation.


RESULTS
A total of 150 children were included. We found a significant increase on the pH parameters in the 1st hour compared to subsequent block times suggesting an effect of anesthesia on GER. We found no significant change in the proportion of studies interpreted as normal vs abnormal, however, excluding the initial 2 h of the study would change the study interpretation from abnormal to normal in up to 5% of patients.


CONCLUSIONS
We found an effect of anesthesia increasing the GER parameters mainly in the 1st hour and up to the first 6 h of the study that may result in a change in the study interpretation.
Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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Rodriguez
Department of Pediatrics, Mass General Hospital for Children, Harvard Medical School, Boston, MA, USA.
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Morley-Fletcher
Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA.
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Souza
Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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Rosengaus
Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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Nurko
D000293:Adolescent; D053704:Capsule Endoscopy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000009:adverse effects*; D050782:Esophageal pH Monitoring / Q000379:methods*; D005260:Female; D005764:Gastroesophageal Reflux; D006801:Humans; D008297:Male; D012189:Retrospective Studies
BRAVO wireless pH; anesthesia; children; gastroesophageal reflux