Alkaline Gastroesophageal Reflux in Infancy

Abstract

SummaryAlkaline gastroesophageal reflux is a rare disorder, although it has been suggested as a cause of esoph‐agitis. However, up to now, there exists no unequivocally accepted diagnostic method for alkaline reflux that can be routinely applied. “Normal ranges” of episodes of pH greater than 7.0–7.5 in asymptomatic as well as in symptomatic infants are proposed. In the asymptomatic infants (n = 83), the mean percentage of time the pH was > 7.0 was 1.3 ± 2.6, and the number of episodes in 24 h with a pH > 7.0 was 10.4 ± 16.4. In the symptomatic group (n = 60), including infants with chronic vomiting, the mean percentage of time the pH was greater than 7.0 was 0.15 ± 0.5, and the number of episodes with a pH greater than 7.0 was 2.8 ± 5.5. In all but six infants the percentage of time the pH was greater than 7.5 was less than 0.1. In three of four of these infants (endoscopy was refused by two parents) whose conditions exceeded the cut‐off limits, there was a histologically proven esophagitis. To evaluate the proposed “normal” ranges for episodes of pH greater than 7.0 and 7.5, 200 symptomatic children were included in a prospective study. Symptoms were repetitive vomiting (n = 110), excessive crying (n = 53), and chronic respiratory disease (n = 37). Esophagoscopy was performed in 18 babies (9%) because pH monitoring data exceeded the proposed limits for the percentage of time the pH was greater than 7.0. The percentage of time the pH was greater than 7.5 was increased in 13 (6.5%) infants. Esophagitis was proven by histologic study in nine infants (4.5% of the total group): in three of nine, reflux was “mixed” (acid and alkaline); in six of nine, reflux was alkaline. If data exceed the proposed limits of episodes with a pH greater than 7.5, alkaline reflux is likely to occur and should be further investigated (e.g., by double esophageal or combined gastric and esophageal pH monitoring) to confirm the diagnosis of alkaline reflux.