Mechanisms of gastro-oesophageal reflux in preterm and term infants with reflux disease

Omari, Taher; Barnett, Christopher; Benninga, Marc A.; Lontis, Ros; Goodchild, Louise; Haslam, Ross; Davidson, Geoffrey P.

doi:10.1136/gut.51.4.475

Cited by 232 publications

(202 citation statements)

References 25 publications

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“…The frequency of high RI and the association with clinical signsmay depend on the diagnostic method used accuracy, as well as the technical conditions and test standardization, such as type and volume of milk, interval between feedings [9,23], and body positioning [25]. On the other hand, findings of high RI in premature infants with GER suggestive symptoms may be attributed, in part, to immaturity or impairment of digestive and respiratory functions [9].…”

Section: Discussionmentioning

confidence: 99%

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High Prevalence of Esophageal Acid Exposure in Very Low Birth Weight Infants Presenting or Not Bronchopulmonary Dysplasia: A Prospective Cross-Sectional Study

Mezzacappa¹

2014

J Neonatal Biol

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IntroductionBronchopulmonary dysplasia (BPD) affects about 22% of very low birth weight (VLBW) newborns [1]. The disease has a turbulent clinical course, significantly contributing to morbidity and mortality in the neonatal period, and leaving long-term sequelae [2].The frequency of Gastroesophageal Reflux (GER) causing symptoms and a complicated clinical course in premature infants presenting BPD during their stay in neonatal care units is not fully established [3][4][5] and widely questioned.Although there is experimental and clinical evidence that sleep apnea occurs as a result of reflux episodes [6,7], the cause-effect relation between the conditions is controversial [8][9][10]. Similarly there is disagreement regarding the effects of GER in the pathogenesis and in BPD recovery [5,11]. The presence of pepsin in the tracheal aspirate in ventilated newborns during the first weeks of life, and the subsequent progression to BPD in these newborns may indicate the possibility of chronic aspiration as a mechanism in the genesis of BPD [12]. Furthermore, there is evidence that symptoms associated with acid reflux episodes that reach or not the pharynx, if cleared slowly, are common in newborns presenting BPD on respiratory support [13,14].Despite the controversies, the presumptive diagnosis of GER has been quite frequent in neonatal units in North America, and there is indication that 24.8% of VLBW infants are treated for the condition [15]. Treatment is even more common (47.6%) among VLBW infants who are discharged after 42 weeks of postmenstrual age, of which 75.7% have DBP [15].Given the uncertainty regarding the occurrence of GER in newborns presenting BPD and the frequency of GER treatment, the prospective study of distal esophagic pH monitoring (DEpHM) abnormalities in newborn infants presenting or not BPD was considered. AbstractBackground: A high frequency of treatment for gastroesophageal reflux disease is observed in neonates with Bronchopulmonary Dysplasia (BPD). The association between these illnesses is controversial.

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Section: Discussionmentioning

confidence: 99%

“…However, this technology does not detect a substantial part of the acid events in premature infants [14,22]. Therefore, acid reflux identified only by pH monitoring (pH only refluxes) has been associated with symptoms related to GERD [23], especially in BPD [14].…”

Section: Discussionmentioning

confidence: 99%

High Prevalence of Esophageal Acid Exposure in Very Low Birth Weight Infants Presenting or Not Bronchopulmonary Dysplasia: A Prospective Cross-Sectional Study

Mezzacappa¹

2014

J Neonatal Biol

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“…[24][25][26] Transient relaxations of lower esophageal sphincter (LES) associated with acid reflux caused by an increase in intra-abdominal pressure is the major mechanism implied in the pathophysiology of GERD in preterm infants. 27,28 Even if some doubt is raised about delayed gastric emptying as an additional mechanism in the genesis of GERD, 27,28 for some individuals, delayed gastric emptying may be the triggering mechanism for transient relaxation. 25 In this study, the probability of GERD increased by 1.67 times (95%CI of 1.11-2.51) for every additional day of gastric tube use.…”

Section: Discussionmentioning

confidence: 99%

Fatores de risco para a doença por refluxo gastroesofágico em recém-nascidos de muito baixo peso portadores de displasia broncopulmonar

Mendes¹,

Mezzacappa²,

Toro³

et al. 2008

J. Pediatr. (Rio J.)

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Objective: To assess risk factors for gastroesophageal reflux disease (GERD) in very low birth weight infants with bronchopulmonary dysplasia. Methods:A case-control study was carried out in 23 cases and 23 control subjects with bronchopulmonary dysplasia submitted to 24-hour esophageal pH monitoring between January 2001 and October 2005. Cases and controls were compared for gestational age, birth weight, gender, use of antenatal steroids, duration of assisted ventilation, duration of oxygen therapy, length of gastric tube use, administration of xanthines, postconceptual age, and weight at esophageal pH monitoring. Multiple logistic regression analysis was used to establish the odds ratio (OR) with a 95% confidence interval (95%CI).Results: None of the groups (with and without GERD) showed statistically significant differences in terms of demographic variables and postnatal outcome, use of antenatal and postnatal corticosteroids, or in terms of caffeine use and duration of mechanical ventilation and oxygen therapy. However, feeding intolerance (OR = 6.55; 95%CI1.05-40.8) and length of gastric tube use (OR = 1.67; 95%CI 1.11-2.51) turned out to be risk factors for GERD.Postconceptual age at the time of pH monitoring (OR = 0.02; 95%CI < 0.001-0.38) was regarded as a protective factor against GERD. Conclusion:The data obtained allow inferring that prolonged gastric tube use and feeding intolerance increase the risk for GERD. On the other hand, older postconceptual age at the time of pH monitoring reduces the risk for GERD in preterm infants with bronchopulmonary dysplasia weighing less than 1,500 g. (Rio J). 2008;84(2):154-159: 24-hour esophageal pH monitoring, bronchopulmonary dysplasia, gastroesophageal reflux disease, gastroesophageal reflux, very low birth weight infants, preterm infants. J Pediatr

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“…Therefore, intraabdominal pressure increases in cases of deep inspiration or stretching and leads to the occurrence of GER. 82% of reflux episodes in premature infants is linked to spontaneous transient LES (12).…”

Section: Pathophysiologymentioning

confidence: 99%

From Newborn to Teenage: Gastroesophageal Reflux

Urgancı¹,

Usta²

2016

JAREM

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Gastroesophageal reflux (GER) is characterized by the involuntary passage of gastric contents into the esophagus. GER disease is defined as a persistent or intermittent passage of gastric contents into the esophagus, which often results in overt clinical signs and symptoms and affects the quality of life. GER is a common disorder in childhood and has a good prognosis. GER in infancy begins within the first month of life, peaks at the 4 th month, and after the first year, it steadily decreases and finally resolves at the age of 2 years. GER physiologically occurs due to the relaxation of the lower esophageal sphincter, independent of swallowing. The mechanisms against GER include the following; 1. Lower esophageal sphincter dysfunction, 2. Clearance effect of esophagus, 3. Esophageal mucosal integrity, and 4. Gastric emptying, which prevent the development of GER disease. Although the physiopathology of GER is still not clearly established, proposed factors are genetic, environmental, anatomic, hormonal, and neurogenic. The most responsible factor is lower esophageal sphincter relaxations. The clinical signs of GER varies with age but commonly appear with gastrointestinal and respiratory symptoms. The diagnosis of GER disease is based on history, physical examination, esophageal pH monitoring, multichannel intraluminal impedance and esophageal manometry, motility examinations, endoscopy, biopsy, examinations with barium, and nuclear scintigraphy. Treatment of GER includes non-pharmacological and pharmacological therapies, such as prokinetic agents and acid suppressors. Surgical treatment indications are relatively limited. (JAREM 2016; 6: 67-73)

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Mechanisms of gastro-oesophageal reflux in preterm and term infants with reflux disease

Cited by 232 publications

References 25 publications

High Prevalence of Esophageal Acid Exposure in Very Low Birth Weight Infants Presenting or Not Bronchopulmonary Dysplasia: A Prospective Cross-Sectional Study

High Prevalence of Esophageal Acid Exposure in Very Low Birth Weight Infants Presenting or Not Bronchopulmonary Dysplasia: A Prospective Cross-Sectional Study

Fatores de risco para a doença por refluxo gastroesofágico em recém-nascidos de muito baixo peso portadores de displasia broncopulmonar

From Newborn to Teenage: Gastroesophageal Reflux

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