Gastroesophageal Reflux and Acute Life-Threatening Episodes: Role of a Central Respiratory Depression

Abstract

The aim of this study was to evaluate plasma levels of β-endorphins in babies with gastroesophageal reflux (GOR) admitted for acute life-threatening episodes (ALTE). In case of ALTE (n = 15), β-endorphin levels were significantly increased compared to sudden infant death syndrome siblings with GOR of a similar gravity evaluated for risk factors (n = 13). β-Endorphin levels are decreased following successful treatment of GOR. Studies of ventilation suggest that changes in the central respiratory drive are associated with a reduction in plasma β-endorphin levels.

Prevalence of Gastroesophageal Reflux in Infants with Recurrent Brief Apneic Episodes

“…Possible mechanisms may involve stimulation of superior laryngeal nerve afferents (35,37), laryngeal and nasopharyngeal receptors (38), and reflex bradycardia (39). It has also been suggested that the esophageal pain caused by GER may trigger beta-endorphin release, which in turn decreases respiratory drive and alters chemolaryngeal reflexes (40,41). Other postulated mechanisms are vagal nerve stimulation (42), GER-induced hypoxemia (29) and anaphylaxis to milk antigens (33).…”

Investigating Esophageal Reflux With the Intraluminal Impedance Technique

“…The height reached by the refluxate in the esophagus was identified as one predictor of GERassociated breathing irregularities (20). Assuming that a complex neurorespiratory reflex pattern protects the lung from exposure to refluxed material (27,28), a reflex "overreaction" could be the cause of apnea or episodes of oxygen desaturation during reflux (29)(30)(31). A predominance of reflux-associated breathing irregularities, an increase of reaction intensity with increased height reached by the refluxate, a decreased reaction readiness during quiet sleep, and the correlation between GER duration and apnea support this speculation (20,21,32,33).…”