Document Detail

Clinical predictors of pathological gastro-oesophageal reflux in infants with persistent distress.
MedLine Citation:
PMID:  16509914     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Gastro-oesophageal reflux (GOR) is common in infants with persistent crying. Empirical treatment with antireflux medications is common practice, although on clinical grounds it may be difficult to determine whether GOR is abnormal. AIMS: To examine the diagnostic accuracy of clinical predictors of pathological GOR in infants with persistent crying. METHODS: One hundred and fifty-one infants (82 male; median age 2.5 months, range 0.5-8.2 months) with persistent crying were prospectively studied. Crying and fussing were charted for 24 h, and parents completed a validated questionnaire on reflux symptoms. All infants underwent oesophageal 24-h pH monitoring. RESULTS: Twenty-seven (17.9%) infants had pathological GOR with a fractional reflux time (FRT) >10%. There was no significant association between total crying duration per 24 and FRT (P = 0.84) or the number of reflux episodes (P = 0.68). Pathological GOR was more common in infants under 3 months, compared to older infants (P = 0.04). Feeding difficulties were significantly associated with pathological GOR (P = 0.02). Backarching was not increased in infants with GOR (P = 0.30). Pathological GOR was significantly associated with the frequency of regurgitation (P = 0.04), but not with vomitus volume (P = 0.62). Regurgitation more than 5 times daily was the most specific reflux symptom (specificity 70.9%), but was a poor predictor of pathological GOR (positive predictive value 22.2%). In the absence of frequent regurgitation or feeding difficulties, pathological GOR was unlikely (negative predictive value 87-90%). CONCLUSIONS: Investigation and treatment of GOR in infants with persistent crying should be primarily directed at infants presenting with frequent regurgitation or feeding difficulties.
Ralf G Heine; Brigid Jordan; Lionel Lubitz; Michele Meehan; Anthony G Catto-Smith
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of paediatrics and child health     Volume:  42     ISSN:  1034-4810     ISO Abbreviation:  J Paediatr Child Health     Publication Date:  2006 Mar 
Date Detail:
Created Date:  2006-03-02     Completed Date:  2007-02-16     Revised Date:  2007-09-24    
Medline Journal Info:
Nlm Unique ID:  9005421     Medline TA:  J Paediatr Child Health     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  134-9     Citation Subset:  IM    
Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Australia.
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MeSH Terms
Age Factors
Analysis of Variance
Breast Feeding
Chronic Disease
Colic* / complications
Crying* / physiology
Esophageal pH Monitoring
Gastroesophageal Reflux / diagnosis*,  physiopathology
Hospitals, Pediatric
Infant Formula
Medical Records
Sex Factors
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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