Influence of respiratory physiotherapy on gastro-oesophageal reflux in infants: A systematic review

Abstract

The evidence is not conclusive on whether respiratory physiotherapy induces or aggravates GOR in infants and small children. Age, disease, and treatment options play an important role. More specific research, also focussing on the influence of respiratory physiotherapy on non-acid reflux and the impact of recently developed airway clearance techniques (ACT's) on GOR is necessary.

Influence of bouncing and assisted autogenic drainage on acid gastro-oesophageal reflux in infants

“…Some authors claim that certain ACT's could exacerbate GOR and even suggest that postural drainage with a head‐down tilt is contra‐indicated in patients with GOR . Our group found that intrapulmonary percussive ventilation (IPV) in upright position does not induce, nor aggravate GOR in infants without and with pathological GOR, respectively …”

Effectiveness of airway clearance techniques in children hospitalized with acute bronchiolitis

“…Previously no benefit has been reported from chest physiotherapy techniques using postural drainage combined with clapping or passive expiratory manoeuvres in children hospitalized for bronchiolitis . The use of postural drainage with head‐down tilt could exacerbate gastro‐oesophageal reflux (GOR) and is contra‐indicated in patients with GOR …”

Influence of intrapulmonary percussive ventilation in upright position on gastro‐oesophageal reflux in infants

“…The few studies concerning chest physiotherapy and its effect on GOR mainly focus on positioning the child with head‐down tilt and are using traditional techniques like percussion, vibrations, chest clapping, and thoracic compression as treatment modalities . More prudence seems justified while treating very young children suffering from pathological GOR or a chronic disease (e.g., infants with CF), especially when combining with gravity‐assisted positions . It is well known that posture has an impact on the frequency of LOS relaxations, one of the physiological mechanisms to increase GOR episodes .…”

“…18,[24][25][26] More prudence seems justified while treating very young children suffering from pathological GOR or a chronic disease (e.g., infants with CF), especially when combining with gravity-assisted positions. 27 It is well known that posture has an impact on the frequency of LOS relaxations, one of the physiological mechanisms to increase GOR episodes. 28 In infants with symptoms attributed to GOR, prone and left lateral position produced a significant reduction in total GOR, compared to supine and right lateral position.…”