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Title: The attempt of identification alkaline gastroesophageal reflux in the youngest children

Janusz Semeniuk, Maciej Kaczmarski, Jolanta Wasilewska, Elżbieta Maciorkowska
Original articles
Polish Gastroenterology
Start page:
Final page:
infants, alkaline GER, oesophagitis, pH measurements, upper gastrointestinal X-ray with barium

Introduction: Alkaline gastroesophageal reflux (alkaline GER) is a seldom disorder in children, especially in the youngest. There is no single, generally accepted diagnostic method for the confirmation of the presence of alkaline GER. Considerable confusion exists over what rangę ofvalueof oesophageal pH constitutes cli-nically significant alkaline GER. To avoid the neutralisation effect of saliva the pH vaue above 7.5 is accepted as the diagnostic criteria for the alkaline GER. Normal ranges were also proposed for number of reflux episodes with the pH values above 7.5 (=20), for the percentage duration of alkaline reflux episodes with reference to the total duration of the esophageal pH monitoring (index=3.4) and for the number of reflux episodes pH>7.5 (=2) that lasted morę than 5 minutes. The aim of study: The aim of the study was the attempt to evaluate alkaline GER in the investigated children considering the characteristics of clinical manifestation and the analysis of the apllied diagnostic methods results. Material and methods: Among all investigated 431 children of both sexes, aged 6 weeks to 36 months (mean age=17.2 months), 93 children (39 girls - 42% and 54 boys - 58%) aged 6 weeks to 13 months (mean age 8.6 months) were found with diverse manifestation and intensity of the clinical symptoms suggesting the GER presence (group 1). The control constitued group 2-95 infants aged 6 weeks to 7 months (mean age=5.5 months) with an ALTE diagnosis due to the reflux symptoms suggesting the presence of this disorder (78/95) or positive family history of ALTE in siblings (17/95). In all examined children 24 hours oesophageal pH monitoring was performed; additionally the children with intensified gastrointestinal symptoms from group 1 had oesophagoscopy and oesophageal biopsies taken for further histopathological evalua-tion. In the patients with respiratory symptoms or suspected of having the respiratory congenital malforma-tions additionally upper gastrointestinal X-ray with barium was performed. Results: The most common reflux symptoms among 18 (19.4%) children selected from group were: vomiting - 5.4%, regurgitation and iiritability (ery) - both 4.3%, wheezing - 3.2% and attacks of cough - 2.2%, and they were similar or identical to the symptoms observed in 12 (15.4%) patients with ALTE from group 2. In the above described group with reflux symptoms 24 hours oeshophageal pH monitoring confirmed the presence of episodes of abnormal inerease of pH values above 7.5 what indicates alkaline shift. The compa-rative assessment of chosen pH-metricparameters(GERindex, number of reflux episodes with pH>7.5and number of reflux episodes with pH>7.5 that lasted morę than 5 min)suggestsstatisticallysignificantlyhigher values in the examined children from group 1 compared to control - group 2. Conclusions: Reflux symptoms observed in 18 (19.4%) investigated children with confirmed alkaline shift of GERare non specific because they are identical or very much alike to those observed in 12 (15.4%) patients with ALTE, where neither acids or alkaline reflux was confirmed. Obtained results from 24 hours oesophageal pH monitoring in investigated children with alkaline shift of GER (group 1) showed the values of pH-metric parameters (pH>7.5) exceeding the cutoff limits of norm and suggested the possibility of identification of alkaline GER even during a single pH monitoring.