Fasting and postprandial mechanisms of gastroesophageal reflux in children with gastroesophageal reflux disease

Abstract

In order to define the mechanisms of gastroesophageal reflux (GER) in children, we performed simultaneous intraluminal esophageal motility and pH studies in 24 children with symptomatic reflux and abnormal prolonged pH probe study, ten (group A) without endoscopic and histologic esophagitis, 14 (group B) with endoscopic and histologic esophagitis. Median (ranges) age (years) was 5.0 (6 months-10 years) and 3.0 (6 months-12 years), respectively. Recordings were done for 1 hr before and 1 hr after feeding apple juice (15 ml/kg; pH 4.0). All episodes of GER in group A patients and 77.1% in group B patients were accounted for by abrupt transient lower esophageal sphincter (LES) relaxation (TLESR); 22.9% of reflux events in group B patients occurred during gradual drifts of LES pressure (LESP) to undetectable levels. Esophageal refluxate exposure (mean percentage time with esophageal pH < 4.0), the rate of TLESR (number of episodes/hr), and the percentage of TLESRs associated with reflux significantly increased in the fed period both in group A (18.5 +/- 5.4%, 6.2 +/- 2.65, 87.1%) and in group B (29.7 +/- 6.5, 7.8 +/- 3.05, 84.9%) as compared to the fasting state (group A: 10.8 +/- 3.9, 3.9 +/- 3.17, 46.1%; group B: 16.1 +/- 2.6, 4.14 +/- 3.06, 55.17%) (p < 0.01). The rate of LESP drifts (number of episodes/hr) was also significantly higher postprandially (4.85 +/- 1.24 vs 1.8 +/- 0.9, p < 0.01); furthermore there was a postfeeding increase of the LESP drift percentage associated with reflux (79.41% vs 46.15%, p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of body position and liquid meal ingestion on esophageal acid exposure time in healthy subjects

“…1,2 The rate of TLESRs associated with gastroesophageal reflux increases significantly after meals. [6][7][8] We hypothesize that distension of the stomach, caused by ingestion of the liquid meal, was responsible for the increased rate of TLESRs. The esophageal acid exposure time in the supine position was significantly greater during each postprandial h compared with the preprandial period.…”

“…[1][2][3][4][5][6] Meals, [6][7][8][9] posture, 6,10-12 and sleep 1,13 are major influences on rates of TLESRs, with rates of TLESRs increasing after meal ingestion and in the upright position. These studies have usually evaluated esophageal acid exposure time during the postprandial period with subjects in the upright position.…”

Pathophysiological mechanisms of Gastroesophageal reflux disease in children

“…Measurements in children with GERD indicate that average LES pressures range from 4 to 25 mm Hg, with most studies recording LES pressures of greater than 10 mm Hg [7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Interestingly, studies that have compared GERD children with "normal" children (ie, those who presented with symptoms but were found to be free of GERD after further investigation) found LES pressure to be 6 to 15 mm Hg lower in children with GERD [7,19].…”

“…The afferent arm of the reflex is initiated by the activation of mechanoreceptors in the wall of the proximal stomach, and the efferent arm is regulated via a brainstem pattern generator. Feeding is a potent stimulus for transient LES relaxations, evidenced by the fact that, in children with GERD, the number of transient LES relaxations increases from 4 per hour in the fasting state to 8 per hour in the fed state [18].…”

Comparação entre uma fórmula infantil pré-espessada e fórmula de espessamento caseiro no tratamento do refluxo gastroesofágico

“…Estudos mostram que, embora muitos fatores contribuam para a gênese do refluxo gastroesofágico, o principal mecanismo etiológico é o relaxamento transitório inadequado do esfíncter esofágico inferior (EEI) 4,5 . Este é definido como o relaxamento do EEI independente da deglutição, não acompanhado de contração peristáltica do esôfago e com duração maior que 5 segundos 6 .…”