title: Gaviscon and domperidon responsive apnea episodes associated with gastro-esophageal reflux disease in twins.
abstract: BACKGROUND
  The possible pathophysiology of the relationship between gastro-esophageal reflux disease and apnea of prematurity has been widely investigated. Various physiological protective reflex responses provide a plausible biological link between gastro-esophageal reflux and apnea of prematurity. It is uncertain whether or not there is a causal relationship between the two diseases. PATIENT'S FINDINGS: Twins were admitted to the neonatal intensive care unit due to feeding problems. Physical examination was normal except for reticulated, blueviolet skin changes. Short apneic attacks occurred on the first day in twin 1 and on the second day in twin 2, and these were initially treated by stimulation and increased ambient O2 concentration. Then, we conducted methylxanthine and continuous positive airway pressure treatment. Laboratory and radiological analysis were normal. As gastro-esophageal reflux disease was thought to be the causes of the treatment-refractory apnea, therapy with gaviscon and domperidon was begun for both cases. Apneic attacks did not recur after gaviscon and domperidon therapy.
  
  
  CONCLUSIONS
  Pharmacological therapy for gastro-esophageal reflux disease has not definitively been shown to be effective in improving symptoms and hence, should be reserved especially for infants with treatment refractory apnea episodes suspected as being gastro-esophageal reflux in premature infants.
authors.affiliation: Department of Pediatrics, Division of Neonatology, Turgut Ozal University, Turkey. Email: hubilgin@hotmail.com.
authors.forename: Huseyin
authors.initials: H
authors.lastname: Bilgin
authors.affiliation: Department of Pediatrics, Division of Neonatology, Turgut Ozal University, Turkey.
authors.forename: Abdulkadir
authors.initials: A
authors.lastname: Eren
authors.affiliation: Department of Pediatrics, Division of Neonatology, Turgut Ozal University, Turkey.
authors.forename: Semra
authors.initials: S
authors.lastname: Kara
mesh_terms: D000464:Alginates / Q000627:therapeutic use*; D000536:Aluminum Hydroxide / Q000627:therapeutic use*; D000863:Antacids; D000932:Antiemetics; D001049:Apnea / Q000628:therapy*; D004200:Diseases in Twins / Q000188:drug therapy*; D004294:Domperidone / Q000627:therapeutic use*; D004338:Drug Combinations; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000188:drug therapy; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000209:etiology / Q000628:therapy*; D012824:Silicic Acid / Q000627:therapeutic use*; D017693:Sodium Bicarbonate / Q000627:therapeutic use*; D014427:Twins
chemical_list: D000464:Alginates; D000863:Antacids; D000932:Antiemetics; D004338:Drug Combinations; D012824:Silicic Acid; D004294:Domperidone; D000536:Aluminum Hydroxide; C007829:alginate, aluminium hydroxide, magnesium trisilicate, sodium bicarbonate drug combination; D017693:Sodium Bicarbonate