Skip to main content
NCBI home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 1998 Jan;78(1):44–48. doi: 10.1136/adc.78.1.44

Gastro-oesophageal reflux in infants under 6 months with cystic fibrosis

R Heine 1, B Button 1, A Olinsky 1, P Phelan 1, A Catto-Smith 1
PMCID: PMC1717422  PMID: 9534675

Abstract

AIM—To establish the incidence of pathological gastro-oesophageal reflux (GOR) in newly diagnosed infants with cystic fibrosis and to identify clinical predictors of increased reflux.
METHODS—26 infants with cystic fibrosis less than 6 months of age (14 male, 12 female; mean (SEM) age 2.1 (0.21) months, range 0.8to 5.6 months) underwent prolonged oesophageal pH monitoring (mean duration 27.1 (0.49) hours; range 21.3 to 30.2 hours). Reflux symptoms, anthropometric variables, pancreatic status, meconium ileus, genotype, and chest x ray findings were correlated with pH monitoring data.
RESULTS—Five infants (19.2%) had an abnormal fractional reflux time of greater than 10%, seven (26.9%) of 5-10%, and 14 (53.8%) of below 5%. Infants who presented with frequent vomiting had a significantly higher fractional reflux time than infants who had infrequent or no vomiting. There was no significant association between abnormal chest x rays and pathological GOR. Sex, genotype, nutritional status, meconium ileus, and pancreatic enzyme supplementation were not significantly associated with pathological GOR.
CONCLUSIONS—About one in five newly diagnosed infants with cystic fibrosis had pathological GOR. Pathologically increased reflux was present before radiological lung disease was established. Apart from frequent vomiting, no useful clinical predictors of pathological reflux were found.



Full Text

The Full Text of this article is available as a PDF (105.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andze G. O., Brandt M. L., St Vil D., Bensoussan A. L., Blanchard H. Diagnosis and treatment of gastroesophageal reflux in 500 children with respiratory symptoms: the value of pH monitoring. J Pediatr Surg. 1991 Mar;26(3):295–300. doi: 10.1016/0022-3468(91)90505-n. [DOI] [PubMed] [Google Scholar]
  2. Bendig D. W., Seilheimer D. K., Wagner M. L., Ferry G. D., Barrison G. M. Complications of gastroesophageal reflux in patients with cystic fibrosis. J Pediatr. 1982 Apr;100(4):536–540. doi: 10.1016/s0022-3476(82)80748-8. [DOI] [PubMed] [Google Scholar]
  3. Button B. M., Heine R. G., Catto-Smith A. G., Phelan P. D., Olinsky A. Postural drainage and gastro-oesophageal reflux in infants with cystic fibrosis. Arch Dis Child. 1997 Feb;76(2):148–150. doi: 10.1136/adc.76.2.148. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Carney B. I., Jones K. L., Horowitz M., Sun W. M., Penagini R., Meyer J. H. Gastric emptying of oil and aqueous meal components in pancreatic insufficiency: effects of posture and on appetite. Am J Physiol. 1995 Jun;268(6 Pt 1):G925–G932. doi: 10.1152/ajpgi.1995.268.6.G925. [DOI] [PubMed] [Google Scholar]
  5. Chow W. H., Finkle W. D., McLaughlin J. K., Frankl H., Ziel H. K., Fraumeni J. F., Jr The relation of gastroesophageal reflux disease and its treatment to adenocarcinomas of the esophagus and gastric cardia. JAMA. 1995 Aug 9;274(6):474–477. [PubMed] [Google Scholar]
  6. Crossley J. R., Elliott R. B., Smith P. A. Dried-blood spot screening for cystic fibrosis in the newborn. Lancet. 1979 Mar 3;1(8114):472–474. doi: 10.1016/s0140-6736(79)90825-0. [DOI] [PubMed] [Google Scholar]
  7. Cucchiara S., Santamaria F., Andreotti M. R., Minella R., Ercolini P., Oggero V., de Ritis G. Mechanisms of gastro-oesophageal reflux in cystic fibrosis. Arch Dis Child. 1991 May;66(5):617–622. doi: 10.1136/adc.66.5.617. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Dab I., Malfroot A. Gastroesophageal reflux: a primary defect in cystic fibrosis? Scand J Gastroenterol Suppl. 1988;143:125–131. doi: 10.3109/00365528809090232. [DOI] [PubMed] [Google Scholar]
  9. Dankert-Roelse J. E., te Meerman G. J. Long term prognosis of patients with cystic fibrosis in relation to early detection by neonatal screening and treatment in a cystic fibrosis centre. Thorax. 1995 Jul;50(7):712–718. doi: 10.1136/thx.50.7.712. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Dent J., Dodds W. J., Friedman R. H., Sekiguchi T., Hogan W. J., Arndorfer R. C., Petrie D. J. Mechanism of gastroesophageal reflux in recumbent asymptomatic human subjects. J Clin Invest. 1980 Feb;65(2):256–267. doi: 10.1172/JCI109667. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Feigelson J., Girault F., Pecau Y. Gastro-oesophageal reflux and esophagitis in cystic fibrosis. Acta Paediatr Scand. 1987 Nov;76(6):989–990. doi: 10.1111/j.1651-2227.1987.tb17283.x. [DOI] [PubMed] [Google Scholar]
  12. Feigelson J., Sauvegrain J. Refux gastro-oesophagien dans la mucoviscidose. Nouv Presse Med. 1975 Nov 8;4(38):2729–2730. [PubMed] [Google Scholar]
  13. FitzSimmons S. C. The changing epidemiology of cystic fibrosis. J Pediatr. 1993 Jan;122(1):1–9. doi: 10.1016/s0022-3476(05)83478-x. [DOI] [PubMed] [Google Scholar]
  14. Gustafsson P. M., Fransson S. G., Kjellman N. I., Tibbling L. Gastro-oesophageal reflux and severity of pulmonary disease in cystic fibrosis. Scand J Gastroenterol. 1991 May;26(5):449–456. doi: 10.3109/00365529108998565. [DOI] [PubMed] [Google Scholar]
  15. Hassall E., Israel D. M., Davidson A. G., Wong L. T. Barrett's esophagus in children with cystic fibrosis: not a coincidental association. Am J Gastroenterol. 1993 Nov;88(11):1934–1938. [PubMed] [Google Scholar]
  16. Heacock H. J., Jeffery H. E., Baker J. L., Page M. Influence of breast versus formula milk on physiological gastroesophageal reflux in healthy, newborn infants. J Pediatr Gastroenterol Nutr. 1992 Jan;14(1):41–46. doi: 10.1097/00005176-199201000-00009. [DOI] [PubMed] [Google Scholar]
  17. Heine R. G., Jaquiery A., Lubitz L., Cameron D. J., Catto-Smith A. G. Role of gastro-oesophageal reflux in infant irritability. Arch Dis Child. 1995 Aug;73(2):121–125. doi: 10.1136/adc.73.2.121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Malfroot A., Dab I. New insights on gastro-oesophageal reflux in cystic fibrosis by longitudinal follow up. Arch Dis Child. 1991 Nov;66(11):1339–1345. doi: 10.1136/adc.66.11.1339. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Scott R. B., O'Loughlin E. V., Gall D. G. Gastroesophageal reflux in patients with cystic fibrosis. J Pediatr. 1985 Feb;106(2):223–227. doi: 10.1016/s0022-3476(85)80291-2. [DOI] [PubMed] [Google Scholar]
  20. Smith H. L., Hollins G. W., Booth I. W., Weller P. H. Gastric emptying of liquids in cystic fibrosis. Acta Univ Carol Med (Praha) 1990;36(1-4):161–164. [PubMed] [Google Scholar]
  21. Stern R. C. The diagnosis of cystic fibrosis. N Engl J Med. 1997 Feb 13;336(7):487–491. doi: 10.1056/NEJM199702133360707. [DOI] [PubMed] [Google Scholar]
  22. Stringer D. A., Sprigg A., Juodis E., Corey M., Daneman A., Levison H. J., Durie P. R. The association of cystic fibrosis, gastroesophageal reflux, and reduced pulmonary function. Can Assoc Radiol J. 1988 Jun;39(2):100–102. [PubMed] [Google Scholar]
  23. Strobel C. T., Byrne W. J., Ament M. E., Euler A. R. Correlation of esophageal lengths in children with height: application to the Tuttle test without prior esophageal manometry. J Pediatr. 1979 Jan;94(1):81–84. doi: 10.1016/s0022-3476(79)80361-3. [DOI] [PubMed] [Google Scholar]
  24. Vandenplas Y., Goyvaerts H., Helven R., Sacre L. Gastroesophageal reflux, as measured by 24-hour pH monitoring, in 509 healthy infants screened for risk of sudden infant death syndrome. Pediatrics. 1991 Oct;88(4):834–840. [PubMed] [Google Scholar]
  25. Vinocur C. D., Marmon L., Schidlow D. V., Weintraub W. H. Gastroesophageal reflux in the infant with cystic fibrosis. Am J Surg. 1985 Jan;149(1):182–186. doi: 10.1016/s0002-9610(85)80030-1. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES