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Managing gastro-oesophageal reflux in infancy
  1. M P Tighe1,
  2. R M Beattie2
  1. 1Paediatric Unit, Poole Hospital, Poole, UK
  2. 2Paediatric Medical Unit, Southampton General Hospital, Southampton, UK
  1. Correspondence to Dr R M Beattie, Paediatric Medical Unit, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; mark.beattie{at}suht.swest.nhs.uk

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Vandenplas et al provide an important insight into the potential impact of positioning on infants with gastrooesophageal reflux (GER) in the report of their experience with the Multicare AR-Bed in the January issue of the journal.1 The bed was utilised to position 3-week to 3-month-old infants with GER at 40°, and the impact on the frequency of regurgitation, the incidence of acid GER and reflux associated symptoms was assessed. The study included 30 infants (of 52 approached) regurgitating more than four times a day for more than 2 weeks with at least one additional reflux-associated symptom such as food refusal, sleep difficulties, back arching or irritability during feeding. These infants had previously had dietary intervention with a thickened hydrolysed formula, or pharmacological intervention (n=20) and had failed to respond. All medication was discontinued more than 3 days before the trial. Twenty-two of 30 (73%) infants tolerated the positioning well. Symptoms were assessed using the I-GERQ-R, a validated symptom score.2 In these infants, the I-GER-Q decreased significantly with use of the bed (p<0.0001), which was utilised for a mean of 3.2 months. The incidence of daily regurgitation was significantly reduced (the mean number of episodes decreased from 6.5 to 2.6; p<0.0001). In addition, 24 h oesophageal pH monitoring was performed in 15 infants beforehand in the supine position without elevation, and after 1 week's trial in the supine position with the bed at 40°, and a significant reduction in the reflux index was demonstrated (14.43 vs 8.81, respectively; p=0.002).

The authors conclude that in children with resistant reflux, supine positioning at 40° elevation with this bed is a useful treatment option, and they call for further trials to assess whether this bed could be used prior to consideration of pharmacological intervention or dietary changes.

GER is a common disorder, …

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