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Distress in Infants and Young Children: Don't Blame Acid Reflux.
J Pediatr Gastroenterol Nutr. 2020 Jul 06 [Online ahead of print]JP

Abstract

OBJECTIVE

The role of gastroesophageal reflux (GER) causing distress in infants is controversial but acid inhibitors are often empirically prescribed. We evaluated the relation between distress assessed by the Face, Legs, Activity, Cry, Consolability (FLACC) scale and GER in infants.

METHODS

We analyzed esophageal impedance-pH monitoring (MII-pH) tracings of infants with persistent unexplained fussiness or distress. Symptoms occurring during investigation were scored by parents using the FLACC scale and were grouped as "distress" episodes.

RESULTS

We recruited 62 children (age 15 days - 23 months, median age 3.5 months). During MII-pH 452 episodes of distress were registered: 217 (48%) were temporally associated with GER and 235 (52%) were not, with no difference in the median value of FLACC between the two groups. Infants with abnormal acid exposure index had a significantly lower FLACC compared to the group with acid reflux index <7% (p < 0.001). When associated with symptoms, GER occurred significantly more often before than simultaneously or after an episode of distress (p = 0.001). Age, proximal extension and duration of GER did not correlate with FLACC scores. Episodes of distress associated with non-acid reflux presented a significant higher FLACC compared to the ones with acid content (FLACC 6 vs 5, p = 0.011). In infants episodes of distress do not significantly correlate with GER.

CONCLUSION

No difference in infant distress noted between proximal and distal GER. Non-acid reflux is perceived at least as painful than acid GER. Our results stress that acid inhibitors should not be started in infants presenting distress unless a clear association with acid GER is demonstrated.

Authors+Show Affiliations

Department of Pediatrics, Ospedale "F. Del Ponte", University of Insubria, Varese, Italy.Department of Pediatrics, Ospedale "F. Del Ponte", University of Insubria, Varese, Italy.KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels Belgium.Department of Pediatrics, Ospedale "F. Del Ponte", University of Insubria, Varese, Italy.Department of Pediatrics, Ospedale "F. Del Ponte", University of Insubria, Varese, Italy.KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels Belgium.Department of Pediatrics, Ospedale "F. Del Ponte", University of Insubria, Varese, Italy.KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels Belgium.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32639449

Citation

Salvatore, Silvia, et al. "Distress in Infants and Young Children: Don't Blame Acid Reflux." Journal of Pediatric Gastroenterology and Nutrition, 2020.
Salvatore S, Pagliarin F, Huysentruyt K, et al. Distress in Infants and Young Children: Don't Blame Acid Reflux. J Pediatr Gastroenterol Nutr. 2020.
Salvatore, S., Pagliarin, F., Huysentruyt, K., Bosco, A., Fumagalli, L., Van De Maele, K., Agosti, M., & Vandenplas, Y. (2020). Distress in Infants and Young Children: Don't Blame Acid Reflux. Journal of Pediatric Gastroenterology and Nutrition. https://doi.org/10.1097/MPG.0000000000002841
Salvatore S, et al. Distress in Infants and Young Children: Don't Blame Acid Reflux. J Pediatr Gastroenterol Nutr. 2020 Jul 6; PubMed PMID: 32639449.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Distress in Infants and Young Children: Don't Blame Acid Reflux. AU - Salvatore,Silvia, AU - Pagliarin,Federica, AU - Huysentruyt,Koen, AU - Bosco,Annalisa, AU - Fumagalli,Letizia, AU - Van De Maele,Kristel, AU - Agosti,Massimo, AU - Vandenplas,Yvan, Y1 - 2020/07/06/ PY - 2020/7/9/entrez JF - Journal of pediatric gastroenterology and nutrition JO - J. Pediatr. Gastroenterol. Nutr. N2 - OBJECTIVE: The role of gastroesophageal reflux (GER) causing distress in infants is controversial but acid inhibitors are often empirically prescribed. We evaluated the relation between distress assessed by the Face, Legs, Activity, Cry, Consolability (FLACC) scale and GER in infants. METHODS: We analyzed esophageal impedance-pH monitoring (MII-pH) tracings of infants with persistent unexplained fussiness or distress. Symptoms occurring during investigation were scored by parents using the FLACC scale and were grouped as "distress" episodes. RESULTS: We recruited 62 children (age 15 days - 23 months, median age 3.5 months). During MII-pH 452 episodes of distress were registered: 217 (48%) were temporally associated with GER and 235 (52%) were not, with no difference in the median value of FLACC between the two groups. Infants with abnormal acid exposure index had a significantly lower FLACC compared to the group with acid reflux index <7% (p < 0.001). When associated with symptoms, GER occurred significantly more often before than simultaneously or after an episode of distress (p = 0.001). Age, proximal extension and duration of GER did not correlate with FLACC scores. Episodes of distress associated with non-acid reflux presented a significant higher FLACC compared to the ones with acid content (FLACC 6 vs 5, p = 0.011). In infants episodes of distress do not significantly correlate with GER. CONCLUSION: No difference in infant distress noted between proximal and distal GER. Non-acid reflux is perceived at least as painful than acid GER. Our results stress that acid inhibitors should not be started in infants presenting distress unless a clear association with acid GER is demonstrated. SN - 1536-4801 UR - https://www.unboundmedicine.com/medline/citation/32639449/Distress_in_Infants_and_Young_Children:_Don't_Blame_Acid_Reflux L2 - https://doi.org/10.1097/MPG.0000000000002841 DB - PRIME DP - Unbound Medicine ER -