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Postural drainage and gastro-oesophageal reflux in infants with cystic fibrosis
  1. Brenda M Buttona,
  2. Ralf G Heineb,
  3. Anthony G Catto-Smithb,
  4. Peter D Phelanc,d,
  5. Anthony Olinskyc
  1. aRoyal Children’s Hospital, Melbourne: Department of Physiotherapy, bDepartment of Gastroenterology, cDepartment of Thoracic Medicine, dDepartment of Paediatrics, University of Melbourne
  1. Dr Anthony G Catto-Smith, Department of Gastroenterology, Royal Children’s Hospital, Flemington Road, Parkville, Victoria 3052, Australia.


Gastro-oesophageal reflux is increased in cystic fibrosis and it is possible that postural drainage techniques may exacerbate reflux, potentially resulting in aspiration and further impairment of pulmonary function.

AIM To evaluate the effects of physiotherapy with head down tilt (standard physiotherapy, SPT) on gastro-oesophageal reflux and to compare this with physiotherapy without head down tilt (modified physiotherapy, MPT).

METHOD Twenty (mean age 2.1 months) infants with cystic fibrosis underwent 30 hour oesophageal pH monitoring during which SPT and MPT were carried out for two sessions each on consecutive days.

RESULTS The number of reflux episodes per hour, but not their duration, was significantly increased during SPT compared with MPT (SPT 2.5 (0.4) v MPT 1.6 (0.3), p = 0.007) and to background (1.1 (0.)1, p = 0.0005). Fractional reflux time was also increased during SPT (11.7 (2.6)%) compared with background (6.9 (1.3)%, p = 0.03) but not compared with MPT (10.7 (2.7)%). There was no significant difference between MPT and background for number of reflux episodes, their duration, or fractional reflux time.

CONCLUSION SPT, but not MPT, was associated with a significant increase in gastro-oesophageal reflux in infants with cystic fibrosis.

  • gastro-oesophageal reflux
  • postural drainage
  • cystic fibrosis
  • pH monitor.
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