title: Effects of Esophageal Acidification on Troublesome Symptoms: An Approach to Characterize True Acid GERD in Dysphagic Neonates.
abstract: To quantify and compare maximal extent (height) of acid reflux events (AREs) on symptom generation in dysphagic neonates. Dysphagic neonates (N = 53), born at 30 ± 5.3 weeks gestation, underwent 24-hour pH-impedance study for the evaluation of troublesome symptoms purported to be due to gastroesophageal reflux disease (GERD). AREs (pH < 4 for >4 s) detected by impedance (Z) were categorized by maximal extent as refluxate reaching distal (Z6, Z5), middle (Z4, Z3), or proximal (Z2, Z1) impedance channels. AREs reaching the pH sensor only were categorized as distal. Symptom correlation (%, symptom index, symptom sensitivity index, and symptom associated probability) and temporal characteristics (clearance times) of AREs were analyzed using linear mixed and GEE models comparing height categories presented as mean ± SEM, median (IQR), and OR (95% CI). Of the 2003 AREs, 1) distal extent AREs (n = 1642) had increased frequency (p < 0.05), decreased ACT (p < 0.05), and decreased acidity (p < 0.05); 2) in middle and proximal AREs, acid clearance was longer than bolus clearance, (p < 0.01); and 3) the odds of having cardiorespiratory (cough or sneeze) symptoms are increased with proximal and middle AREs (p < 0.05). Most proximal ascent of AREs into middle or proximal esophagus likely activates protective aerodigestive reflexes (peristalsis) or vigilant states to facilitate bolus and chemical clearance. Heightened esophageal sensitivity, acid neutralization delays, or clearance mechanism delays may accentuate multi-systemic troublesome symptoms.
authors.affiliation: Innovative Neonatal and Infant Feeding Disorders Program, Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Maneesha
authors.initials: M
authors.lastname: Sivalingam
authors.affiliation: Innovative Neonatal and Infant Feeding Disorders Program, Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Swetha
authors.initials: S
authors.lastname: Sitaram
authors.affiliation: Innovative Neonatal and Infant Feeding Disorders Program, Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Hasenstab
authors.affiliation: Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH, USA.
authors.forename: Lai
authors.initials: L
authors.lastname: Wei
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.|Division of Pediatric Gastroenterology and Nutrition, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
authors.forename: Frederick W
authors.initials: FW
authors.lastname: Woodley
authors.affiliation: Innovative Neonatal and Infant Feeding Disorders Program, Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA. Sudarshan.Jadcherla@nationwidechildrens.org.|Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA. Sudarshan.Jadcherla@nationwidechildrens.org.|Division of Pediatric Gastroenterology and Nutrition, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA. Sudarshan.Jadcherla@nationwidechildrens.org.|Division of Neonatology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA. Sudarshan.Jadcherla@nationwidechildrens.org.
authors.forename: Sudarshan R
authors.initials: SR
authors.lastname: Jadcherla
mesh_terms: D003680:Deglutition Disorders / Q000209:etiology*; D017097:Electric Impedance; D050782:Esophageal pH Monitoring / Q000379:methods*; D004947:Esophagus / Q000737:chemistry* / Q000503:physiopathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D016014:Linear Models; D008297:Male; D010528:Peristalsis / Q000502:physiology
keywords: Acid reflux; Deglutition; Deglutition disorders; Dysphagia; GERD; Swallowing