Acid and non-acid reflux during physiotherapy in young children with cystic fibrosis

✍ Scribed by Michael Doumit; Usha Krishnan; Adam Jaffé; Yvonne Belessis

• Publisher: John Wiley and Sons
• Year: 2011
• Tongue: English
• Weight: 168 KB
• Volume: 47
• Category: Article
• ISSN: 8755-6863
• DOI: 10.1002/ppul.21524

✦ Synopsis

Abstract

Background

Gastro‐esophageal reflux (GOR) may contribute to lung disease in children with cystic fibrosis (CF). There is conflicting evidence regarding the effect of chest physiotherapy (CPT) in the head‐down position on GOR. Furthermore, there is currently no evidence on the impact of physiotherapy on GOR as assessed by pH‐multichannel intraluminal impedance (pH‐MII).

Aims

(1) To characterize GOR in young children with CF. (2) To determine whether the head‐down position during physiotherapy exacerbates GOR.

Methods

Children were studied using pH‐MII monitoring over 24‐hr, during which they received two 20‐min sessions of CPT. One session was performed in “modified” drainage positions with no head‐down tilt and the alternate session in “gravity‐assisted” drainage positions, which included 20° head‐down tilt.

Results

Twenty children with CF (8 males), median age 12 months (range 8–34) were recruited. A total of 1,374 reflux episodes were detected in all children, of which 869 (63%) were acid and 505 (37%) were non‐acid. Seventy‐two percent of the episodes migrated proximally. During CPT, there was no significant difference between total number of reflux episodes in the modified or gravity‐assisted positions, median [inter‐quartile range (IQR)] 1 (0–2.5) compared to 1 (0.75–3) episode, respectively, P = 0.63. There was also no significant difference between the number of reflux episodes which migrated proximally, median (IQR) 1 (0–2) compared to 0 (0–2) episodes, respectively, P = 0.75.

Conclusion

In young children with CF, GOR is primarily acidic and proximal migration is common. Physiotherapy in the head‐down position does not appear to exacerbate GOR. The impact of GOR on lung disease remains to be elucidated. Pediatr Pulmonol. 2012; 47:119–124. © 2011 Wiley Periodicals, Inc.