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. 1996 Sep;75(2):F117–F121. doi: 10.1136/fn.75.2.f117

Gastric emptying and gastro-oesophageal reflux in preterm infants.

A K Ewer 1, G M Durbin 1, M E Morgan 1, I W Booth 1
PMCID: PMC1061175  PMID: 8949695

Abstract

Gastro-oesophageal reflux is common in preterm infants, but the role of gastric emptying as a causal factor has not been studied before. Gastric emptying was therefore measured in 19 healthy preterm infants (median gestational age 32 weeks) while concurrently measuring 24 hour lower oesophageal pH, using an antimony pH electrode, positioned manometrically. Real time ultrasonic images of the gastric antrum were obtained, and measurements of antral cross-sectional area (ACSA) were made immediately before a nasogastric feed and then during subsequent gastric emptying until ACSA returned to its pre-feed value. Half emptying time (50% delta ACSA) was calculated as the time taken for the ACSA to fall to half the maximal postprandial increment. Mean (SEM) reflux index for the group was 11.9 (2.0)%; number of reflux episodes per 24 hours: 15.4 (1.7); and number of reflux episodes longer than five minutes 5.5 (0.8). Average half emptying times for an individual infant were: median (range) 46 (18-105) minutes. There was no association between gastric emptying rates and any of the indices of gastro-oesophageal reflux, either during the entire 24 hour period for which the lower oesophageal pH was recorded, or in the postprandial periods after the feeds which were studied ultrasonically. Gastro-oesophageal reflux was also unrelated to feed volume and feed type. Asymptomatic gastro-oesophageal reflux is common in preterm infants, but gastric emptying time is not a determinant of it. Inappropriate relaxation of the lower oesophageal sphincter or abnormal oesophageal motility offer more plausible explanations.

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Selected References

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  1. Andres J. M., Mathias J. R., Clench M. H., Davis R. H. Gastric emptying in infants with gastroesophageal reflux. Measurement with a technetium-99m-labeled semisolid meal. Dig Dis Sci. 1988 Apr;33(4):393–399. doi: 10.1007/BF01536020. [DOI] [PubMed] [Google Scholar]
  2. Carroccio A., Iacono G., Li Voti G., Montalto G., Cavataio F., Tulone V., Lorello D., Kazmierska I., Acierno C., Notarbartolo A. Gastric emptying in infants with gastroesophageal reflux. Ultrasound evaluation before and after cisapride administration. Scand J Gastroenterol. 1992 Sep;27(9):799–804. doi: 10.3109/00365529209011187. [DOI] [PubMed] [Google Scholar]
  3. Cucchiara S., Santamaria F., Andreotti M. R., Minella R., Ercolini P., Oggero V., de Ritis G. Mechanisms of gastro-oesophageal reflux in cystic fibrosis. Arch Dis Child. 1991 May;66(5):617–622. doi: 10.1136/adc.66.5.617. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Cunningham K. M., Horowitz M., Riddell P. S., Maddern G. J., Myers J. C., Holloway R. H., Wishart J. M., Jamieson G. G. Relations among autonomic nerve dysfunction, oesophageal motility, and gastric emptying in gastro-oesophageal reflux disease. Gut. 1991 Dec;32(12):1436–1440. doi: 10.1136/gut.32.12.1436. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Di Lorenzo C., Piepsz A., Ham H., Cadranel S. Gastric emptying with gastro-oesophageal reflux. Arch Dis Child. 1987 May;62(5):449–453. doi: 10.1136/adc.62.5.449. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Dodds W. J., Dent J., Hogan W. J., Helm J. F., Hauser R., Patel G. K., Egide M. S. Mechanisms of gastroesophageal reflux in patients with reflux esophagitis. N Engl J Med. 1982 Dec 16;307(25):1547–1552. doi: 10.1056/NEJM198212163072503. [DOI] [PubMed] [Google Scholar]
  7. Ewer A. K., Durbin G. M., Morgan M. E., Booth I. W. Gastric emptying in preterm infants. Arch Dis Child Fetal Neonatal Ed. 1994 Jul;71(1):F24–F27. doi: 10.1136/fn.71.1.f24. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Georgieff M. K., Hoffman J. S., Pereira G. R., Bernbaum J., Hoffman-Williamson M. Effect of neonatal caloric deprivation on head growth and 1-year developmental status in preterm infants. J Pediatr. 1985 Oct;107(4):581–587. doi: 10.1016/s0022-3476(85)80028-7. [DOI] [PubMed] [Google Scholar]
  9. Guillet J., Wynchank S., Christophe E., Basse-Cathalinat B., Ducassou D., Blanquet P. Gastro-oesophageal reflux and gastric emptying of liquids in paediatric patients. Int J Nucl Med Biol. 1984;11(3-4):254–258. doi: 10.1016/0047-0740(84)90008-1. [DOI] [PubMed] [Google Scholar]
  10. Heacock H. J., Jeffery H. E., Baker J. L., Page M. Influence of breast versus formula milk on physiological gastroesophageal reflux in healthy, newborn infants. J Pediatr Gastroenterol Nutr. 1992 Jan;14(1):41–46. doi: 10.1097/00005176-199201000-00009. [DOI] [PubMed] [Google Scholar]
  11. Hillemeier A. C., Lange R., McCallum R., Seashore J., Gryboski J. Delayed gastric emptying in infants with gastroesophageal reflux. J Pediatr. 1981 Feb;98(2):190–193. doi: 10.1016/s0022-3476(81)80633-6. [DOI] [PubMed] [Google Scholar]
  12. Jolley S. G., Leonard J. C., Tunell W. P. Gastric emptying in children with gastroesophageal reflux. I. An estimate of effective gastric emptying. J Pediatr Surg. 1987 Oct;22(10):923–926. doi: 10.1016/s0022-3468(87)80590-0. [DOI] [PubMed] [Google Scholar]
  13. Maddern G. J., Chatterton B. E., Collins P. J., Horowitz M., Shearman D. J., Jamieson G. G. Solid and liquid gastric emptying in patients with gastro-oesophageal reflux. Br J Surg. 1985 May;72(5):344–347. doi: 10.1002/bjs.1800720505. [DOI] [PubMed] [Google Scholar]
  14. Mahony M. J., Migliavacca M., Spitz L., Milla P. J. Motor disorders of the oesophagus in gastro-oesophageal reflux. Arch Dis Child. 1988 Nov;63(11):1333–1338. doi: 10.1136/adc.63.11.1333. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Newell S. J., Booth I. W., Morgan M. E., Durbin G. M., McNeish A. S. Gastro-oesophageal reflux in preterm infants. Arch Dis Child. 1989 Jun;64(6):780–786. doi: 10.1136/adc.64.6.780. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Newell S. J., Morgan M. E., Durbin G. M., Booth I. W., McNeish A. S. Does mechanical ventilation precipitate gastro-oesophageal reflux during enteral feeding? Arch Dis Child. 1989 Oct;64(10 Spec No):1352–1355. doi: 10.1136/adc.64.10_spec_no.1352. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Newell S. J., Sarkar P. K., Durbin G. M., Booth I. W., McNeish A. S. Maturation of the lower oesophageal sphincter in the preterm baby. Gut. 1988 Feb;29(2):167–172. doi: 10.1136/gut.29.2.167. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Omari T. I., Miki K., Fraser R., Davidson G., Haslam R., Goldsworthy W., Bakewell M., Kawahara H., Dent J. Esophageal body and lower esophageal sphincter function in healthy premature infants. Gastroenterology. 1995 Dec;109(6):1757–1764. doi: 10.1016/0016-5085(95)90741-6. [DOI] [PubMed] [Google Scholar]
  19. Papaila J. G., Wilmot D., Grosfeld J. L., Rescorla F. J., West K. W., Vane D. W. Increased incidence of delayed gastric emptying in children with gastroesophageal reflux. A prospective evaluation. Arch Surg. 1989 Aug;124(8):933–936. doi: 10.1001/archsurg.1989.01410080065010. [DOI] [PubMed] [Google Scholar]
  20. Schwizer W., Hinder R. A., DeMeester T. R. Does delayed gastric emptying contribute to gastroesophageal reflux disease? Am J Surg. 1989 Jan;157(1):74–81. doi: 10.1016/0002-9610(89)90422-4. [DOI] [PubMed] [Google Scholar]
  21. Shay S. S., Eggli D., McDonald C., Johnson L. F. Gastric emptying of solid food in patients with gastroesophageal reflux. Gastroenterology. 1987 Feb;92(2):459–465. doi: 10.1016/0016-5085(87)90142-9. [DOI] [PubMed] [Google Scholar]
  22. Sondheimer J. M., Clark D. A., Gervaise E. P. Continuous gastric pH measurement in young and older healthy preterm infants receiving formula and clear liquid feedings. J Pediatr Gastroenterol Nutr. 1985 Jun;4(3):352–355. doi: 10.1097/00005176-198506000-00005. [DOI] [PubMed] [Google Scholar]
  23. Staiano A., Cucchiara S., Del Giudice E., Andreotti M. R., Minella R. Disorders of oesophageal motility in children with psychomotor retardation and gastro-oesophageal reflux. Eur J Pediatr. 1991 Jul;150(9):638–641. doi: 10.1007/BF02072624. [DOI] [PubMed] [Google Scholar]
  24. Tolia V., Lin C. H., Kuhns L. R. Gastric emptying using three different formulas in infants with gastroesophageal reflux. J Pediatr Gastroenterol Nutr. 1992 Oct;15(3):297–301. doi: 10.1097/00005176-199210000-00011. [DOI] [PubMed] [Google Scholar]
  25. Velasco N., Hill L. D., Gannan R. M., Pope C. E., 2nd Gastric emptying and gastroesophageal reflux. Effects of surgery and correlation with esophageal motor function. Am J Surg. 1982 Jul;144(1):58–62. doi: 10.1016/0002-9610(82)90602-x. [DOI] [PubMed] [Google Scholar]

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