New study helps clarify symptoms and characteristics of acid reflux in neonates
Modifying stomach acid levels may not be enough to treat symptoms in neonates suspected of having gastroesophageal reflux disease. According to a study from Nationwide Children's Hospital, this is the first study to classify reflux and its associated symptoms in neonates based on how and what is refluxed.
Gastroesophageal reflux disease (GERD) is a frequent consideration in infants at risk of the life-threatening events chronic lung disease and dysphagia. Yet, the definition of GERD in neonates and infants and its treatment remains controversial. Acid suppressive medications and prokinetics are commonly prescribed to alter gastric acidity and improve gastrointestinal motility in neonates, yet such therapies can have harmful side effects.
"It's difficult to distinguish whether symptoms of reflux are part of a neonate's normal functioning or if they are disease-based," said study author, Sudarshan Jadcherla, MD, FRCPI, DCH, AGAF, neonatology and principal investigator in the Center for Perinatal Research of The Research Institute at Nationwide Children's Hospital. "As such, there are no definite standards to aid in the management of reflux among neonates in the intensive care unit, nor clarity regarding symptom recognition, nor standards to aid in the diagnosis of GERD."
Dr. Jadcherla, also medical director of the Neonatal and Infant Feeding Disorders Program and professor of Pediatrics at The Ohio State University College of Medicine and Public Health, says that establishing objective evidence of gastroesophageal reflux events and the relationship of symptoms with the physical or chemical composition of the refluxate is essential to characterize whether patients have a disease that needs treatment.
To help characterize reflux events, Nationwide Children's investigators evaluated 30 neonates in Nationwide Children's NICU who were suspected to have GERD. Using pH-impedance studies, the team determined refluxate presence, composition, distribution and clearing time. Nurses also documented whether the neonates showed any respiratory symptoms (coughing, gagging, grunting), sensory symptoms (irritability, grimacing, crying) or physical movement such as stretching of their limbs, during the identified reflux events.
Findings showed that:
- Non-acid reflux events are of equal frequency as acid reflux events and the majority of events spread proximally above the upper esophageal sphincter.
- Acid clearance time per acid ph-impedance event was lesser than ph-only events.
- Infra-upper esophageal sphincter reflux was correlated with higher percentage of acid reflux events compared to supra-upper esophageal sphincter reflux events.
- Supra-upper esophageal sphincter reflux events were associated with greater proportion of non-acid reflux events.
- Fifty-four percent of reflux events documented by pH-impedance were associated with symptoms. More than 87 percent of the pH-only events were associated with symptoms.
- Symptomatic acid reflux events were associated with longer acid clearance time.
- Prolonged acidity was associated with symptomatic acid reflux events in chronic lung disease patients.
"It is clear from this study that symptoms can occur with acid, non-acid, gas, liquid or mixed events," said Dr. Jadcherla. "So, treatment strategies based on modifying gastric acidity alone can be ineffective as acid is not the lone provoking agent."
Dr. Jadcherla says it is also clear why the management of GERD based on symptoms only is controversial, as there are reflux-type symptoms in the absence of reflux.
"Overall, this study helps clarify the definition of GERD: gastroesophageal reflux with increased frequency of respiratory, sensory or movement symptoms," said Dr. Jadcherla.
Provided by Nationwide Children's Hospital
- No link between acid reflux and survival Jan 04, 2008 | not rated yet | 0
- New studies reveal that night-time acid reflux can impact sleep Oct 15, 2007 | not rated yet | 0
- Obesity linked to acid reflux disease Dec 12, 2006 | not rated yet | 0
- Are manometric findings different between the patients with erosive and nonerosive disease? Dec 08, 2009 | not rated yet | 0
- Molecular imaging reveals origin of acid reflux disease Jun 08, 2010 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
A new case of the deadly coronavirus has been detected in Saudi Arabia where 15 people have already died after contracting it, the health ministry announced on Saturday on its Internet website.
Diseases, Conditions, Syndromes 1 hour ago | not rated yet | 0
(HealthDay)—Few randomized clinical trials have been done to assess clinical prediction rules for patients with lower back pain, and the trials that have been done are of low quality and do not provide ...
Diseases, Conditions, Syndromes 22 hours ago | not rated yet | 0 |
A new, highly sensitive blood test that quickly detects even the lowest levels of malaria parasites in the body could make a dramatic difference in efforts to tackle the disease in the UK and across the world, according to ...
Diseases, Conditions, Syndromes May 17, 2013 | not rated yet | 0
(AP)—The World Health Organization says a yellow fever booster vaccination given 10 years after the initial shot isn't necessary.
Diseases, Conditions, Syndromes May 17, 2013 | not rated yet | 0
An increasing number of U.S. children are experiencing gastrointestinal issues that require interventions to resolve, according to research presented at Digestive Disease Week (DDW).
3 hours ago | not rated yet | 0 |
The latest makeover to a massive psychiatric tome honored by some, reviled by others and even called the "Bible" of mental disorders is being released Saturday with a host of new changes.
1 hour ago | not rated yet | 0
A ground-breaking advance in colonoscopy technology signals the future of colorectal care, according to research presented today at Digestive Disease Week(DDW). Additional research focuses on optimizing the minimal withdrawal ...
3 hours ago | 5 / 5 (1) | 0
Big names in medicine are set to give an upbeat assessment of the war on AIDS on Tuesday, 30 years after French researchers identified the virus that causes the disease.
11 hours ago | 5 / 5 (1) | 0
For combat veterans suffering from post-traumatic stress disorder, 'fear circuitry' in the brain never rests
Chronic trauma can inflict lasting damage to brain regions associated with fear and anxiety. Previous imaging studies of people with post-traumatic stress disorder, or PTSD, have shown that these brain regions can over-or ...
12 hours ago | 5 / 5 (1) | 0 |
The neural machinery underlying our olfactory sense continues to be an enigma for neuroscience. A recent review in Neuron seeks to expand traditional ideas about how neurons in the olfactory bulb might encode information about ...
23 hours ago | not rated yet | 0 |