ABSTRACT
Carbohydrate solutions that empty rapidly from the stomach have been shown to produce less gastroesophageal reflux (GER) during the postcibal period than more slowly emptying formulas. These observations have not been extended to complete infant formulas containing fat, carbohydrate, and protein constituents. Medium chain triglyceride has been shown to significantly accelerate gastric emptying compared to long chain triglyceride for preterm infants when investigated in commercial infant formulas. Using a previously reported acidified formula model coupled with esophageal pH probe testing, we have documented in a group of 28 infants that modification of formula by enrichment with medium chain triglyceride produced no improvement in rates of GER during the first 2 h after feeding.
Subject(s)
Gastroesophageal Reflux/drug therapy , Infant Food , Triglycerides/therapeutic use , Gastroesophageal Reflux/physiopathology , Humans , Hydrogen-Ion Concentration , Infant , Infant Food/analysis , Infant, Newborn , Time FactorsABSTRACT
To facilitate the detection of postcibal gastroesophageal reflux (GER), we have constructed an infant formula from modular carbohydrate, fat, and protein components with a pH of 4 and a nutrient composition identical to standard infant formula. In comparison to standard infant formula and sugar solutions, this pH-adjusted formula demonstrates a significantly greater amount of gastroesophageal reflex during the first postcibal hour. We speculate that the greater caloric density and slower gastric emptying of regular infant formula promotes greater gastroesophageal reflux than is observed with regular dextrose feedings. This effect is obscured unless the pH of the formula is adjusted. Use of this weakly acid formula in conjunction with postcibal esophageal pH probe recording facilitates the detection and, during simultaneous apnea monitoring, potential association of symptoms with postcibal gastroesophageal reflux.
Subject(s)
Gastroesophageal Reflux/diagnosis , Hydrogen-Ion Concentration , Infant Food , Humans , InfantABSTRACT
In a group of 19 infants being evaluated for gastro-esophageal reflux, we investigated the effects of various carbohydrate solutions (glucose polymers, 5% dextrose in water, and 10% dextrose in water) on the rate of postcibal gastroesophageal reflux during the first 2 h after a test feeding. The high-osmolality feeding (10% dextrose in water) produced significantly more postcibal gastroesophageal reflux over the entire 2-h interval. The major difference occurred in the second postcibal hour when the amount of gastroesophageal reflux was persistently high for 10% dextrose in water in contrast to the other feedings. We speculate that more rapid gastric emptying of low-osmolality solutions may account for these differences. Clear liquid feeding composition should be standardized during pH testing. Low-osmolality glucose polymer solutions may be more easily tolerated by infants with gastro-esophageal reflux who require carbohydrate or fluid supplements.
Subject(s)
Dietary Carbohydrates , Gastroesophageal Reflux/diagnosis , Infant Food , Energy Intake , Gastric Emptying , Glucose , Humans , Hydrogen-Ion Concentration , Infant , Osmolar Concentration , Time FactorsABSTRACT
Using esophageal pH monitoring, we have investigated the effect of feeding volume on early (1 h) postcibal gastroesophageal reflux (GER) in a population of 50 infants referred for evaluation. Two feedings with the volume of both feedings specified (9 and 18 ml/kg) were given to one group of infants. A second group was given one feeding ad libitum and another specified at 9 ml/kg. Volume of intake was a very significant determinant of both the total duration and the maximum single continuous episode of GER during early postcibal esophageal pH monitoring in both groups by paired analyses. This effect was observed in infants with significant GER (n = 44) and in a subgroup of infants who were normal (n = 6).
Subject(s)
Eating , Gastroesophageal Reflux/etiology , Infant Food , Esophagus/physiology , Humans , Hydrogen-Ion Concentration , Infant , Monitoring, Physiologic , Time FactorsABSTRACT
Using prolonged esophageal pH monitoring, we examined 42 infants referred for gastroesophageal reflux (GER) over a 16-month interval. Eighteen of these infants were also examined with intragastric pH monitoring following a standard formula meal. We found that prematurity and postcibal gastric acidity were significantly correlated with the amount of GER observed. Historical symptoms appeared to have little correlation with the amount of GER as measured by prolonged intraesophageal pH monitoring.
Subject(s)
Gastric Acid/metabolism , Gastric Acidity Determination/methods , Gastroesophageal Reflux/physiopathology , Age Factors , Buffers , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/etiology , Humans , Infant , Infant Food/analysis , Infant, Newborn , Infant, Premature, Diseases/diagnosis , Infant, Premature, Diseases/etiology , Infant, Premature, Diseases/physiopathology , Monitoring, PhysiologicABSTRACT
A variety of peptic diseases are treated with antacids. Antacid dose requirements for young children have not been extensively evaluated. Moreover, the effects of formula feedings on antacid requirements are also unknown. We have investigated the effects of antacids and formula feedings on gastric acidity in infants less than 1 year of age. Small formula feedings of 15 mL/kg per feeding significantly improve antacid buffering of 0.5 mL/kg per dose of standard magnesium-aluminum hydroxide antacids.
