Is acid gastroesophageal reflux in children with ALTE etiopathogenetic factor of life threatening symptoms?

Abstract

Purpose: Commonly described multiorgan manifestation of acid GER: primary and secondary to cow's milk allergy and/or other food (CMA/FA) sometimes coexists with ALTE (Apparent Life Threatening Events) syndrome symptoms. Among these symptoms are apnea, cyanosis, pallor, hypotonia, non-epileptic seizures, consciousness disorders and bradycardia.

Materials and methods: 264 children aged: 4-102 months (x=20.78 +/- 17.23 months) of both sexes, with symptoms suggestive of GER were enrolled into study. 8 children (4.8%) aged up to 2 years (x=10.00 +/- 2.78 months) of both sexes with symptoms suggestive of ALTE were selected from the group. 24-hour esophageal pH monitoring was used for acid GER diagnosis in these children. X-ray of esophagus with barium swallow was performed in order to evaluate the height of GER in infants. Immunoallergologic tests were performed in order to differentiate acid GER: primary and secondary to food allergy in these children.

Aims: (1) Assessment of the prevalence of acid GER in children with symptoms suggestive of ALTE, (2) Clinical evaluation of symptoms in children with ALTE and acid GER, (3) Assessment of efficacy of conservative treatment in children with reflux and ALTE symptoms, (4) Natural regression of the disease in children with ALTE Results: From among 264 examined children who underwent 24-hour esophageal pH monitoring acid GER was confirmed in 170 (64.4%), and ALTE in 8 (4.8%). The causative role of primary acid GER in children with ALTE regarded to 4 children (50.0%) and GER secondary concerned 4 remaining children (50.0%). Mean number of ALTE episodes that appeared before admission to the hospital was similar in both study groups. The presence of typical reflux symptoms in 5 (62.5%) out of 8 children with ALTE symptoms on the basis of primary or secondary acid GER is significant. Mean value of total acid GER index in a subgroup of children with primary GER constituted x = 11.13 +/- 1.45 and was not statistically significant in comparison with mean value x = 12.13 +/- 1.30 of a parameter measured in a subgroup of children with secondary GER. The most common clinical manifestation was apnea and it was of identical prevalence in both study subgroups. Analysis of clinical differentiation of the course of ALTE in children with primary and secondary acid GER under conservative therapy was performed. Under this therapy, gradual regression of ALTE symptoms was achieved in all (8/100.0%) patients, with a tendency to longer time of improvement in children with secondary GER. Typical and atypical symptoms of GER receded in a subgroup with primary GER and were alleviated in a subgroup with secondary GER. In the second half year of clinical observation aggravation of reflux and ALTE symptoms was observed in subgroups. In the second year of clinical observation various typical and atypical symptoms of GER were observed in both subgroups. All these malaises during this period coexisted with ALTE symptoms. In the third year of clinical observation in both subgroups ALTE symptoms connected with acid GER were not observed.

Conclusion: Primary and secondary GER were defined as the causative factors of ALTE in 8 (4.8%) examined infants.