Effect of intragastric volume and osmolality on mechanisms of gastroesophageal reflux in children with gastroesophageal reflux disease

Salvia, G.; Vizia, B. De; Manguso, Francesco; Iula, Vita Dora; Terrin, Gianluca; Spadaro, Raffaella; Russo, Gianluca; Cucchiara, Salvatore

doi:10.1111/j.1572-0241.2001.03865.x

Cited by 54 publications

(25 citation statements)

References 29 publications

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“…This observation is in line with the biomechanical theory, according to which excessive (lasting many years) stretching of the stomach walls, e.g. due to big meals and air accumulating in the fundus of the stomach during eating, leads to weakening the mechanisms regulating the functions of lower oesophageal sphincter (LES) [11]. The association between large meals and heartburn has also been shown in papers by other authors [8, 12].…”

Section: Discussionsupporting

confidence: 86%

Risk factors for gastroesophageal reflux disease – the role of diet

Jarosz¹,

Taraszewska²

2014

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IntroductionNutrition can contribute to the development of gastroesophageal reflux disease (GERD). The relevant studies often provide contradictory results.AimTo determine GERD risk factors associated with dietary habits.Material and methodsA total of 513 subjects were included. The study group consisted of adults with a recent clinically confirmed diagnosis of GERD, and the control group were healthy adults. The research tool was a proprietary questionnaire. Risk factors were evaluated by logistic regression models.ResultsAn association was found between the severity of typical GERD symptoms and a certain diet (p < 0.001). The symptoms were experienced more often after fatty, fried, sour, or spicy food and sweets. The univariate logistic regression analysis showed the following risk factors: eating 1–2 meals per day (OR = 3.50, 95% CI: 1.75–6.98), everyday consumption of peppermint tea (OR = 2.00, 95% CI: 1.14–3.50), and eating one, big meal in the evening instead of dinner and supper (OR = 1.80, 95% CI: 1.05–3.11). The multivariate analysis confirmed that frequent peppermint tea consumption was a risk factor (OR = 2.00, 95% CI: 1.08–3.70).ConclusionsTaking into consideration the results of this study, it seems that patients should be recommended to eat more than three meals a day and eat dinner and supper at appropriate times instead of one, big meal in the evening. The role of frequent peppermint tea consumption in GERD development requires further studies.

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Section: Discussionsupporting

confidence: 86%

Risk factors for gastroesophageal reflux disease – the role of diet

Jarosz¹,

Taraszewska²

2014

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“…This autonomic improvement may act not only in the EGJ but also in the stomach to reduce tLESR. Disturbed postprandial meal distribution in the stomach is associated with increased tLESR in children fed with high volume and osmolality meal (25), and GERD patients have reduced proximal stomach meal retention (12). It is possible that autonomic function improvement in GERD would counteract motor derangements like the last one.…”

Section: Discussionmentioning

confidence: 99%

Inspiratory muscle training improves antireflux barrier in GERD patients

Souza

Lima

Martins

et al. 2013

American Journal of Physiology-Gastrointestinal and Liver Physi

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Nobre e Souza MÂ, Lima MJ, Martins GB, Nobre RA, Souza MH, de Oliveira RB, dos Santos AA. Inspiratory muscle training improves antireflux barrier in GERD patients. Am J Physiol Gastrointest Liver Physiol 305: G862-G867, 2013. First published October 10, 2013 doi:10.1152/ajpgi.00054.2013.-The crural diaphragm (CD) is an essential component of the esophagogastric junction (EGJ), and inspiratory exercises may modify its function. This study's goal is to verify if inspiratory muscle training (IMT) improves EGJ motility and gastroesophageal reflux (GER). Twelve GER disease [GERD; 7 males, 20 -47 yr, 9 esophagitis, and 3 nonerosive reflex disease (NERD)] and 7 healthy volunteers (3 males, 20 -41 yr) performed esophageal pH monitoring, manometry, and heart rate variability (HRV) studies. A 6-cm sleeve catheter measured average EGJ pressure during resting, peak inspiratory EGJ pressures during sinus arrhythmia maneuver (SAM) and inhalations under 17-, 35-, and 70-cmH2O loads (TH maneuvers), and along 1 h after a meal. GERD patients entered a 5-days-a-week IMT program. One author scored heartburn and regurgitation before and after IMT. IMT increased average EGJ pressure (19.7 Ϯ 2.4 vs. 29.5 Ϯ 2.1 mmHg; P Ͻ 0.001) and inspiratory EGJ pressure during SAM (89.6 Ϯ 7.6 vs. 125.6 Ϯ 13.3 mmHg; P ϭ 0.001) and during TH maneuvers. The EGJ-pressure gain across 35-and 70-cmH2O loads was lower for GERD volunteers. The number and cumulative duration of the transient lower esophageal sphincter relaxations decreased after IMT. Proximal progression of GER decreased after IMT but not the distal acid exposure. Low-frequency power increased after IMT and the higher its increment the lower the increment of supine acid exposure. IMT decreased heartburn and regurgitation scores. In conclusion, IMT improved EGJ pressure, reduced GER proximal progression, and reduced GERD symptoms. Some GERD patients have a CD failure, and IMT may prove beneficial as a GERD add-on treatment. crural diaphragm; GERD; lower esophageal sphincter; muscle training

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“…The practice of simply concentrating standard formulas may involve several risks, including increased incidence of nausea, vomiting, diarrhea, and gastroesophageal reflux due to high osmolality feedings (Sutphen and Dillard, 1989;Salvia et al, 2001), nitrogen and other solute overload and insufficient water for growth (Pereira et al, 1994), hypertonic dehydration by exceeding the potential renal solute load (Ziegler and Fomon, 1989), and excessive mineral intake predisposing to nephrocalcinosis (Puangco and Schanler, 2000).…”

Section: Discussionmentioning

confidence: 99%

“…Supplementing standard formulas (Raffles et al, 1983;Puangco and Schanler, 2000) or breast milk (De Curtis et al, 1999;Fenton and Belik, 2002) by adding GP increases the osmolality of the feeds. Hyperosmolar feeds have been shown to empty from the stomach more slowly than isotonic solutions and are associated with an increased incidence of nausea, vomiting, diarrhea, and gastroesophageal reflux (Sutphen and Dillard, 1989;Salvia et al, 2001). Considering the risks associated with hyperosmolar feedings, 400 mOsm/kg is the maximum recommended safe osmolality for infant formulas (AAP CON, 1976).…”

Section: Introductionmentioning

confidence: 99%

Osmolality of preterm formulas supplemented with nonprotein energy supplements

et al. 2007

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Background: Addition of energy supplements to preterm formulas is an optional strategy to increase the energy intake in infants requiring fluid restriction, in conditions like bronchopulmonary dysplasia. This strategy may lead to an undesirable increase in osmolality of feeds, the maximum recommended safe limit being 400 mOsm/kg. The aim of the study was to measure the changes in osmolality of several commercialized preterm formulas after addition of glucose polymers and medium-chain triglycerides. Methods: Osmolality was measured by the freezing point depression method. Six powdered formulas with concentrations of 14 g/100 ml and 16 g/100 ml, and five ready-to-feed liquid formulas were analyzed. All formulas, were supplemented with 10% (low supplementation) or 20% (high supplementation) of additional calories, respectively, in the form of glucose polymers and medium chain triglycerides, maintaining a 1:1 glucose:lipid calorie ratio. Inter-analysis and intra-analysis coefficients of variation of the measurements were always o 3.9%. Results: The mean osmolality (mOsm/kg) of the non-supplemented formulas varied between 268.5 and 315.3 mOsm/kg, increasing by 3-5% in low supplemented formulas, and by 6-10% in high supplemented formulas. None of the formulas analyzed exceeded 352.8 mOsm/kg. Conclusion: The supplementation of preterm formulas with nonprotein energy supplements with up to 20% additional calories did not exceed the maximum recommended osmolality for neonatal feedings.

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Effect of intragastric volume and osmolality on mechanisms of gastroesophageal reflux in children with gastroesophageal reflux disease

Cited by 54 publications

References 29 publications

Risk factors for gastroesophageal reflux disease – the role of diet

Risk factors for gastroesophageal reflux disease – the role of diet

Inspiratory muscle training improves antireflux barrier in GERD patients

Osmolality of preterm formulas supplemented with nonprotein energy supplements

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