Pediatr Gastroenterol Hepatol Nutr.  2017 Sep;20(3):153-159. 10.5223/pghn.2017.20.3.153.

Not All Children with Cystic Fibrosis Have Abnormal Esophageal Neutralization during Chemical Clearance of Acid Reflux

Affiliations
  • 1Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA. Frederick.Woodley@nationwidechildrens.org
  • 2Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
  • 3Biostatistics Core, Nationwide Children's Hospital, Columbus, OH, USA.
  • 4Department of Pediatrics, Federal University of Sao Paulo, Sao Paulo, Brazil.
  • 5Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
  • 6Research Institute and Neonatology, Nationwide Children's Hospital, Columbus, OH, USA.
  • 7Division of Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
  • 8Department of Pediatrics, OSU University of Cincinnati College of Medicine, Cincinnati, OH, USA.
  • 9Division of Gastroenterology, Rady Children's Hospital, San Diego, CA, USA.
  • 10Department of Pediatrics, The University of California at San Diego College of Medicine, San Diego, CA, USA.

Abstract

PURPOSE
Acid neutralization during chemical clearance is significantly prolonged in children with cystic fibrosis, compared to symptomatic children without cystic fibrosis. The absence of available reference values impeded identification of abnormal findings within individual patients with and without cystic fibrosis. The present study aimed to test the hypothesis that significantly more children with cystic fibrosis have acid neutralization durations during chemical clearance that fall outside the physiological range.
METHODS
Published reference value for acid neutralization duration during chemical clearance (determined using combined impedance/pH monitoring) was used to assess esophageal acid neutralization efficiency during chemical clearance in 16 children with cystic fibrosis (3 to <18 years) and 16 age-matched children without cystic fibrosis.
RESULTS
Duration of acid neutralization during chemical clearance exceeded the upper end of the physiological range in 9 of 16 (56.3%) children with and in 3 of 16 (18.8%) children without cystic fibrosis (p=0.0412). The likelihood ratio for duration indicated that children with cystic fibrosis are 2.1-times more likely to have abnormal acid neutralization during chemical clearance, and children with abnormal acid neutralization during chemical clearance are 1.5-times more likely to have cystic fibrosis.
CONCLUSION
Significantly more (but not all) children with cystic fibrosis have abnormally prolonged esophageal clearance of acid. Children with cystic fibrosis are more likely to have abnormal acid neutralization during chemical clearance. Additional studies involving larger sample sizes are needed to address the importance of genotype, esophageal motility, composition and volume of saliva, and gastric acidity on acid neutralization efficiency in cystic fibrosis children.

Keyword

Chemical clearance; Acid neutralization; Impedance; Cystic fibrosis; Child

MeSH Terms

Child*
Cystic Fibrosis*
Electric Impedance
Gastric Acid
Genotype
Humans
Reference Values
Saliva
Sample Size
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