Mechanisms of gastro-oesophageal reflux in cystic fibrosis.

Abstract

Abnormal degrees of gastro-oesophageal reflux (GOR) were detected by 24 hour intraoesophageal pH measurement in 12 of 14 children (mean age 7-9 years; range 5 months-16 years) affected by cystic fibrosis and complaining of symptoms suggesting GOR. These patients underwent combined recording of distal oesophageal motility and intraluminal pH in order to investigate mechanisms of GOR. Inappropriate lower oesophageal sphincter relaxation was the most common mechanism of reflux in all patients. Other mechanisms (appropriate relaxation or lowered pressure of the lower oesophageal sphincter, increased intragastric pressure) were detected less frequently. Frequency of inappropriate lower oesophageal sphincter relaxations was significantly higher in patients with cystic fibrosis than in other study groups (symptomatic GOR, GOR disease complicated by respiratory complaints). Inappropriate lower oesophageal sphincter relaxations occurred with the same frequency in patients with cystic fibrosis and in a group of children with GOR disease complicated by oesophagitis. Abnormalities of distal oesophageal contractions such as decreased amplitude or uncoordinated waves were also recorded in cystic fibrosis patients. Seven patients with cystic fibrosis completed a therapeutic trial for eight weeks consisting of postural treatment and oral cisapride, a new prokinetic drug. The oesophageal acid exposure improved in only three patients. We conclude that pathologic GOR is commonly asssociated with cystic fibrosis. The predominant reflux mechanism in these patients is a transient inappropriate lower oesophageal sphincter relaxation rather than a low steady state basal lower oesophageal sphincter pressure.

Holding the baby: head downwards positioning for physiotherapy does not cause gastro-oesophageal reflux

“…A slumped position raises intra-abdominal pressure and this is one mechanism that may induce GOR [11]. Transient relaxations of the lower oesophageal sphincter (LOS), a cause of GOR, especially in CF [12], are also more frequent when sitting [13]. A head-downward tipped position may prevent GOR as intra-abdominal pressure falls and intrathoracic pressure rises, thus actually reducing the adverse gradient across the LOS which would otherwise favour reflux [14].…”

Change in physiotherapy management of children with cystic fibrosis in a large urban hospital

“…Changes in management styles therefore cannot be attributed to changes within the population, and are not a reflection of underlying changes within the groups. 18 (Button et al, 1997(Button et al, , 1998Cucchiara et al, 1991;Malfroot and Dab, 1991). Exacerbation of symptoms in a child with ENT pathology, or discomfort in children with gastrostomies or venous access implants in a head-down position may also be a factor.…”

The effect of gastric juice on interleukin-8 production by cystic fibrosis primary bronchial epithelial cells

“…It has been suggested that micro-aspiration might play an important role in the pathophysiology of reflux-related respiratory disorders, probably in addition to other mechanisms like the esophagobronchial reflex pathway and bronchial hypersensitivity. There are several protective mechanisms against aspiration, such as esophageal clearance, which has been suggested to be altered in the CF population, and reflex closure of the UES and/or vocal cords [2,16,17]. In healthy subjects, gastric aspirate may be cleared very rapidly from the lungs.…”