Heartburn Babies

Acid reflux disease is different between newborns and adults

(RxWiki News) In the health care world, babies are different creatures than adults. Although babies can get some of the same diseases as adults, they may show different signs and need different treatments.

Newborns suspected of having acid reflux disease - when stomach contents leak back into the esophagus - need treatment that goes beyond controlling their stomach acid levels.

"Newborns with acid reflux should be treated differently than adults."

It is hard to tell whether the signs of acid reflux are simply part of the way a newborn functions or if they are actually caused by disease, says study author Sudarshan Jadcherla, M.D., F.R.C.P.I., D.C.H., A.G.A.F., from the Center for Perinatal Research of The Research Institute at Nationwide Children's Hospital.

Because of this difficulty, explains Dr. Jadcherla, there are no clear standards to help doctors and parents manage acid reflux in newborn children. In addition, there is still much debate about how best to spot symptoms and diagnose the disease in newborns.

In order to get closer to having some clear standards for treating acid reflux in newborns, Dr. Jadcherla and colleagues set out to help define acid reflux events. According to the researchers, this study is the first to classify acid reflux and its symptoms in newborns based on how and what is leaked back up through the esophagus (i.e. refluxed).

The study's results show that symptoms of acid reflux can be caused by more than just stomach acids. Newborns can experience symptoms caused by acid, non-acid, gas, liquid, and mixed events, says Dr. Jadcherla.

Acid reflux is commonly treated using drugs that keep stomach acid levels down. However, these drugs can have some harmful side effects, especially for newborns.

Dr. Jadcherla recommends that newborns get treatment that goes beyond controlling stomach acids, as acids are not the sole cause of disease symptoms.

For their research, Dr. Jadcherla and colleagues studied 30 newborns who were suspected of having acid reflux disease (also known as GERD) in Nationwide Children's Neonatal Intensive Care Unit. They assessed whether refluxate (the stuff that comes up from the stomach) was present; what the refluxate was made of; where the refluxate leaked to; and how long it took to clear the refluxate.

They researchers looked for respiratory symptoms like coughing, gagging, and grunting. They also looked for sensory symptoms - such as irritability, grimacing, and crying - or physical movement while the newborns experienced reflux events.

The results show that:

  • Non-acid reflux events were equally as common as acid reflux events
  • Most of the reflux events spread above the upper esophageal sphincter - the muscle that opens during swallowing so that food can pass through
  • Acid clearance time per acid ph-impedance event was less than ph-only events
  • Infra-upper esophageal sphincter reflux was correlated with higher percentage of acid reflux events compared to supra-upper esophageal sphincter reflux events
  • Supra-upper esophageal sphincter reflux events were associated with greater proportion of non-acid reflux events
  • Fifty-four percent of reflux events documented by pH-impedance were associated with symptoms. More than 87 percent of the pH-only events were associated with symptoms
  • Symptomatic acid reflux events were associated with longer acid clearance time
  • Prolonged acidity was associated with symptomatic acid reflux events in chronic lung disease patients

The full study is published in the journal Pediatric Research.

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Review Date: 
August 9, 2011