Patterns of Gastroesophageal Reflux (GER) in Patients with Apparent Life-Threatening Events

Newman, Leonard S.; Russe, Jose; Glassman, Mark S.; Berezin, Stuart; Halata, Michael S.; Medow, Marvin S.; Dozor, Allen J.; Schwarz, Steven M.

doi:10.1097/00005176-198902000-00006

Cited by 47 publications

(26 citation statements)

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“…We failed to confirm that during sleep, apnoeic infants have a greater reflux density than non-ALTE infants. This observation contrasts with previous reports [15,22]. We do not know whether this discrepancy is related to the methodology of our study, such as selection of patients, supine body position, simultaneous recording of polysomnographic and pH variables, the duration of the reflux studied, or proximal positioning of the probe.…”

Section: Discussioncontrasting

confidence: 97%

Lack of temporal relation between acid reflux in the proximal oesophagus and cardiorespiratory events in sleeping infants

et al. 1992

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We studied sleeping infants in order to investigate whether a temporal relation exists between acid reflux extending to the proximal portion of the oesophagus and cardiorespiratory events. One hundred infants with occasional regurgitations were studied: 50 infants admitted after an apparently life-threatening event (ALTE) that occurred during sleep and that remained unexplained despite medical investigation, and 50 asymptomatic infants (non-ALTE). The infants had a median age of 8 weeks (range 4-26 weeks); 54 were boys. In each child a pH probe was placed in the proximal portion of the thoracic oesophagus, under radiological control. Polygraphic monitoring of state of alertness, cardiorespiratory activity, and proximal oesophageal pH changes was conducted continuously during 1 night. The data were analysed blind. In 80 infants a total of 186 decreases in oesophageal pH below 4 units were seen; 37% occurred during wakefulness, and 40% during rapid eye movement (REM) sleep. A total of 7029 central and 61 obstructive apnoeas were monitored, mainly during REM sleep. Within 5 min before, and 5 min after the drops in pH, there was no difference in the number, or the duration of bradycardia, central, mixed, or obstructive apnoea. The infants with an ALTE could not be differentiated from the non-ALTE infants for any of the variables studied. It is concluded that spontaneous acid refluxes extending to the proximal portion of the oesophagus during sleep are usually not temporally related with the development of apnoeas or bradycardias.

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Section: Discussioncontrasting

confidence: 97%

Lack of temporal relation between acid reflux in the proximal oesophagus and cardiorespiratory events in sleeping infants

et al. 1992

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“…Most of the children suffered from ALTE post‐prandially, 27 independently of whether or not they were diagnosed with acid GOR. Although this similarity between the two groups may seem illogical at first, we have to remember that up to 78% of the episodes of reflux are not acid 28 and that only a study of the pH can detect acid events.…”

Section: Discussionmentioning

confidence: 99%

Increased incidence of apparently life‐threatening events due to supine position

Maggio

Schäppi

Benkebil³

et al. 2006

Paediatric Perinatal Epid

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Gastro-oesophageal reflux (GOR) has a high prevalence in infancy. The supine position is among numerous aggravating factors. The exact relationship between GOR and apparently life-threatening events (ALTE) is not clear, although it has been repeatedly investigated. In 1992 the worldwide Back to Sleep campaign was implemented, which had a dramatic effect on the incidence of sudden infant death syndrome (SIDS) with a drop of 50%. Although the vast majority of children now sleep on their back, the effect of this position on ALTE has not been studied. In this retrospective study, we aim to define the potential association between GOR and ALTE. We hypothesise that the incidence of ALTE has increased since the 1992 recommendation. No bias in the population's selection was introduced, as our centre is the only one for paediatric emergencies in the county. A total of 107 children presenting with ALTE were identified during the study period (1987-99). A pH study was performed in the 75 patients presenting with ALTE in the last 6 years of the study (1994-99). Neither morbidity nor mortality was noted in a long-term 4-year follow-up. Our present results show that the frequency of ALTE increased sevenfold (P < 0.005) between 1992 and 1999. The ALTE episodes took place significantly more often in the post-prandial period. The prevalence of GOR was much higher in patients presenting with ALTE (nearly 75%) when compared with the general population. Furthermore, on medical treatment for GOR, very few patients presented with a second episode of ALTE. Consequently it is thought that GOR and ALTE are linked and that ALTE patients would benefit from GOR treatment. The worldwide marked decrease in SIDS since the implementation of the supine position possibly masks the negative effect of an increase in ALTE.

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“…An increased prevalence of GER in infants with ALTE has been documented [1,19]. However, other studies did not find such relationship [13,21].…”

Section: Introductionmentioning

confidence: 98%

Autonomic function, gastroesophageal reflux in apparent life threatening event

2010

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Patterns of Gastroesophageal Reflux (GER) in Patients with Apparent Life-Threatening Events

Cited by 47 publications

References 0 publications

Lack of temporal relation between acid reflux in the proximal oesophagus and cardiorespiratory events in sleeping infants

Lack of temporal relation between acid reflux in the proximal oesophagus and cardiorespiratory events in sleeping infants

Increased incidence of apparently life‐threatening events due to supine position

Autonomic function, gastroesophageal reflux in apparent life threatening event

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