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Carabelli G, Binotto I, Armano C, Bertù L, Luini C, Nosetti L, Agosti M, Salvatore S. Study on Nocturnal Infant Crying Evaluation (NICE) and Reflux Disease (RED). CHILDREN (BASEL, SWITZERLAND) 2024; 11:450. [PMID: 38671666 PMCID: PMC11048841 DOI: 10.3390/children11040450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/31/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Nocturnal infant crying is often empirically treated with acid suppressants. The aim of this study was to evaluate the prevalence and characteristics of gastroesophageal reflux (GER) in infants with unexplained persistent crying. METHODS We enrolled all infants (0-12 months) referred for suspected GER disease who underwent esophageal impedance-pH monitoring (MII-pH) for unexplained persistent crying not improved by parental reassurance, dietary modification or alginate. Gastrointestinal malformation/surgery, neurological impairment and infections were exclusion criteria. Demographic and anthropometric parameters, GER symptoms and questionnaires (I-GERQ-R) and MII-pH data were recorded and analyzed. Normal MII-pH was defined when acid exposure was <3%, symptom index was <50% and symptom association probability was <95%. Acid exposure >5% and >10% was also considered. Statistical analysis was performed using Chi-Square and univariate and multivariable regression analysis. RESULTS We included 50 infants (median age 3.5 months) who fulfilled the study criteria: 30 (60%) had normal MII-pH. I-GERQ-R score was abnormal in 33 (66%) infants, and 21/33 (64%) had normal MII-pH (p = 0.47). In the 26 (52%) infants with nocturnal crying, MII-pH was normal in 16 (54%) (p = 0.82). Associated regurgitation (>3 or >10 episodes/die) did not predict abnormal MII-pH (p = 0.74, p = 0.82, respectively). Univariate and multivariable regression analysis did not identify any clinical variable significantly associated with abnormal MII-pH. CONCLUSIONS Infants with persistent unexplained and nocturnal crying should not be empirically treated with acid inhibitors.
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Affiliation(s)
- Greta Carabelli
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
| | - Ivan Binotto
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
| | - Chiara Armano
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
| | - Lorenza Bertù
- Research Center Tromboembolic Diseases, University of Insubria, 21100 Varese, Italy;
| | - Chiara Luini
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
| | - Luana Nosetti
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
| | - Massimo Agosti
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
| | - Silvia Salvatore
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
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Gonçalves EDS, Ribeiro JD, Marson FAL, Montes CG, Ribeiro AF, Mainz JG, Toro AADC, Zamariola JH, Borgli DSP, Lomazi EA, Servidoni MDFCP. Combined multi-channel intraluminal impedance measurement and pHmetry in the detection of gastroesophageal reflux disease in children with cystic fibrosis. J Pediatr (Rio J) 2022; 99:269-277. [PMID: 36564006 DOI: 10.1016/j.jped.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To assess the prevalence of GERD exclusively by means of multichannel intraluminal impedanciometry associated with pH monitoring (MIIpH) and compare it with respiratory symptoms in children with CF. To compare MIIpH with pHmetry alone to perform GERD diagnosis. METHODS An analytical cross-sectional study was conducted with children diagnosed with CF who underwent MIIpH. Clinical and laboratory markers, including respiratory and digestive symptoms, were used for comparative analyses. High-resolution chest computed tomography was performed on patients with symptoms of chronic lung disease. Severity was classified according to the Bhalla score. RESULTS A total of 29 children < 10 yo (18 girls) were evaluated; 19 of whom with physiological GER and 10 with GERD. Of the children with GERD, seven had predominantly acid GER, two acid+non-acid GER, and one non-acid GER. Three patients had GERD diagnosed only by MIIpH. Bhalla scores ranged from seven to 17.75 with no significant relationship with GERD. The number of pulmonary exacerbations was associated with a decrease in esophageal clearance regardless of the position in pHmetry and MIIpH. CONCLUSIONS The prevalence of GERD was 34% in children with CF. There was no association between respiratory disease severity and GER types. MIIpH detected 30% more patients with GERD than pHmetry.
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Affiliation(s)
- Emília da Silva Gonçalves
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Pediatria, Centro de Pesquisa Pediátrica, Laboratório de Fibrose Cística e Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil.
| | - José Dirceu Ribeiro
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Pediatria, Centro de Pesquisa Pediátrica, Laboratório de Fibrose Cística e Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil.
| | - Fernando Augusto Lima Marson
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Pediatria, Centro de Pesquisa Pediátrica, Laboratório de Fibrose Cística e Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil; Universidade São Francisco, Laboratório de Genética Médica e Medicina Genômica, Pós-Graduação em Ciências da Saúde, Bragança Paulista, SP, Brazil; Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Centro de Diagnóstico de Doenças do Aparelho Digestivo (Gastrocentro), Campinas, SP, Brazil
| | - Ciro Garcia Montes
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Centro de Diagnóstico de Doenças do Aparelho Digestivo (Gastrocentro), Campinas, SP, Brazil
| | - Antônio Fernando Ribeiro
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Pediatria, Centro de Pesquisa Pediátrica, Laboratório de Fibrose Cística e Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil
| | - Jochen Georg Mainz
- University Klinikum Westbrandenburg Klinik für Kinder- und Jugendmedizin, Brandenburg Medical School (MHB), Head of Pediatric Pulmonology and Cystic Fibrosis, Hochstraße, Germany
| | - Adyléia Aparecida Dalbo Contrera Toro
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Pediatria, Centro de Pesquisa Pediátrica, Laboratório de Fibrose Cística e Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil
| | - Juliana Helena Zamariola
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Pediatria, Centro de Pesquisa Pediátrica, Laboratório de Fibrose Cística e Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil
| | - Daniela Souza Paiva Borgli
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Pediatria, Centro de Pesquisa Pediátrica, Laboratório de Fibrose Cística e Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil
| | - Elizete Aparecida Lomazi
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Pediatria, Centro de Pesquisa Pediátrica, Laboratório de Fibrose Cística e Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil
| | - Maria de Fátima Corrêa Pimenta Servidoni
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Pediatria, Centro de Pesquisa Pediátrica, Laboratório de Fibrose Cística e Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil; Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Centro de Diagnóstico de Doenças do Aparelho Digestivo (Gastrocentro), Campinas, SP, Brazil
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Tam SS, Picoraro JA, Gupta SK, Oliva S, Furlano RI, Walsh CM. Changes to Pediatric Gastroenterology Practice During the COVID-19 Pandemic and Lessons Learned: An International Survey of Division and Group Heads. Gastroenterology 2021; 161:1052-1055. [PMID: 33675745 PMCID: PMC8093127 DOI: 10.1053/j.gastro.2021.02.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/24/2021] [Accepted: 02/28/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Sharon S Tam
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Joseph A Picoraro
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Medical Center, New York, New York
| | - Sandeep K Gupta
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Illinois, University of Illinois, Peoria, Illinois
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Umberto I-University Hospital, Sapienza-University of Rome, Rome, Italy
| | - Raoul I Furlano
- Pediatric Gastroenterology and Nutrition, Department of Pediatrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, Ontario, Canada.
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