Allergy Asthma Immunol Res.  2012 Jan;4(1):17-23. 10.4168/aair.2012.4.1.17.

The Efficacy of the Upright Position on Gastro-Esophageal Reflux and Reflux-Related Respiratory Symptoms in Infants With Chronic Respiratory Symptoms

• Jung WJ
• Yang HJ
• Min TK
• Jeon YH
• Lee HW
• Lee JS
• Pyun BY

• KMID: 2130374
• DOI: http://doi.org/10.4168/aair.2012.4.1.17

Abstract

PURPOSE
Gastro-esophageal reflux (GER), particularly non-acid reflux, is common in infants and is a known cause of chronic respiratory symptoms in infancy. Recent guidelines recommended empirical acid suppression therapy and the head-up position in patients with suspected GER. However, the efficacy of the upright position in relieving GER and reflux-related respiratory symptoms in infants is unclear. We conducted this study to investigate the efficacy of the upright position on GER and reflux-related respiratory symptoms in infants with chronic respiratory symptoms.
METHODS
Thirty-two infants (21 male; median age, 5 months; range, 0 to 19 months) with unexplained chronic respiratory symptoms underwent multi-channel intraluminal esophageal impedance and pH monitoring. We retrospectively compared the frequencies of GER and reflux-related symptoms according to body position.
RESULTS
A mean of 3.30 episodes of reflux per hour was detected. Overall, refluxes were more frequent during the postprandial period than the emptying period (3.77 vs. 2.79 episodes/hour, respectively; P=0.01). Although there was no significant difference in the total refluxes per hour between the upright and recumbent positions (6.12 vs. 3.77 episodes, P=0.10), reflux-related respiratory symptoms per reflux were significantly fewer in infants kept in an upright position than in a recumbent position during the postprandial period (3.07% vs. 14.75%, P=0.016). Non-acid reflux was the predominant type of reflux in infants, regardless of body position or meal time.
CONCLUSIONS
The upright position may reduce reflux-related respiratory symptoms, rather than reflux frequency. Thus, it may be a useful non-pharmacological treatment for infantile GER disease resistant to acid suppressants.

Keyword

Gastroesophageal reflux; infant; esophageal pH monitoring

MeSH Terms

Electric Impedance
Esophageal pH Monitoring
Gastroesophageal Reflux
Humans
Hydrogen-Ion Concentration
Infant
Meals
Postprandial Period
Retrospective Studies

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