Role of gastro-oesophageal reflux in infant irritability.

Abstract

Gastro-oesophageal reflux (GOR) disease may cause excessive crying in infants. The role of GOR was evaluated in infant irritability and an attempt was made to define clinical predictors of pathological reflux. Seventy consecutively admitted infants with irritability and presumptive GOR were retrospectively reviewed. All had undergone prolonged oesophageal pH monitoring. Pathological GOR was defined as a fractional reflux time of 210% and was significantly less common in infants under 3 months (one of 24; 4.2%) than in older infants (10 of 46; 21.7%). All infants with pathological GOR presented with frequent vomiting, and 'silent' pathological reflux did not occur. Poor weight gain, feeding refusal, backarching, and sleep disturbance were not significantly associated with pathological GOR. The results suggest that pathological GOR is an unlikely cause of infant irritability under the age of 3 months. (Arch Dis Child 1995; 73: 121-125)

Natural course of gastroesophageal reflux disease during infancy - six-month follow-up

“…11 Hematemesis and frequent vomiting are predictors of pathological reflux in irritable infants. 10 Maternal diaries in our study recorded 3 symptoms other than regurgitation, i.e., hiccup, vomiting and back arching. Orenstein et al also identify these symptoms in healthy infants.…”

“…9 Recent studies suggest that GER sometimes associated with failure to thrive, but the prevalence of this is unknown. 3,8,10 Very few data have been published about the natural course of GER symptoms during infancy; further, no risk factors of GERD have been identified. This study aimed to determine the natural course of regurgitation in infancy, the percentage of GERD in infantile regurgitation, and the predictive factor of GERD.…”

Gastroesophageal Reflux

“…However, there is no evidence for this hypothesis. In the paper by Heine et al, all infants with pathological GER presented with frequent vomiting, and "silent" pathological reflux did not occur [40]. Poor weight gain, feeding refusal, back arching, and sleep disturbance were not significantly associated with pathological GER [40].…”

“…GERD is only one of the many etiologies of "feeding problems" in infancy. Poor weight gain, feeding refusal, back arching, irritability, and sleep disturbances have been reported to be related as well as unrelated to GERD [1,2,40].…”

“…In recent years, these normal developmental processes have increasingly been ascribed to pathology and treated with medical therapies, including acid suppressants [162]. GERD may cause excessive crying in infants [40]. The concept that infant irritability and sleep disturbances are manifestations of GER is largely extrapolated from adult descriptions of heartburn and sleep disturbances that improve with antacid therapy OA [158] 1-11 month During double-blind treatment, there were no significant differences between pantoprazole and placebo in withdrawal rates due to lack of efficacy Winter (2012) OA [56] 1-11 month During double-blind treatment, there were no significant differences between esomeprazole and placebo in withdrawal rates due to lack of efficacy OA [159] 1-11 years Symptom improvement Gold (2007) OA [160] 12-17 years Symptom improvement Shashidhar (2013) Rev [161] 0-18 years PPIs are effective in healing reflux esophagitis in children of all ages but do not improve GER-related symptoms in infants The table is not exhaustive but lists the papers on Pubmed between 2007 and 2013 with "proton pump inhibitor infant" and "proton pump inhibitor pediatric" as search terms and illustrates the differences in outcome according to age of the patients PPI proton pump inhibitor, H²RA histamine receptor antagonists, RCTs randomized controlled trials, GERD gastroesophageal reflux disease [1].…”