Continuous positive airway pressure and gastroesophageal reflux: an experimental study

Abstract

Gastroesophageal reflux (GER) often occurs in babies receiving respiratory assistance for neonatal distress. The authors examined the lower esophageal sphincter and the thoracic and abdominal pressure conditions in rats under progressively higher continuous positive airway pressure (CPAP) to test the efficacy of the antireflux barrier under such conditions. Intrathoracic and intraabdominal pressures were recorded within the esophagus and within the inferior vena cava in 10 anaesthesized 250-g male rats. Pull-through techniques were used for lower esophageal sphincter pressure (LESP) and length (LESL) studies, and the length of the intraabdominal segment of the esophagus (LIASE) was also determined. Measurements were performed in baseline conditions and at CPAP levels of 0, 1, 3, 5, and 7 cm H2O. The respiratory effort progressively increased with prolonged expiration and decreased frequency. LESP and LESL did not change significantly, but the antireflux barrier was weakened by a progressive shortening of LIASE. Successive CPAP increases led to increasingly negative thoracic pressures during inspiration, and increasingly positive abdominal pressures during expiration yielded progressively greater transdiaphragmatic pressure gradients. The authors suggest that CPAP weakens the antireflux barrier and, at the same time, increases the gastroesophageal pressure gradient, thus increasing the risk of GER. Although transpolation of experimental data to the clinical setting is always hazardous, the authors believe this issue should be investigated in infants.