Effects of Esophageal Acidification on Troublesome Symptoms: An Approach to Characterize True Acid GERD in Dysphagic Neonates.

This was an observational study of symptom timing, not a treatment trial, so it cannot show that acid suppression or any other therapy improves symptoms. The infants were selected from those referred for troublesome symptoms suspected to be due to reflux, and infants with genetic or chromosomal abnormalities or receiving acid suppressive medications or prokinetics were excluded, so findings may not apply to all infants with feeding difficulty. The pH sensor position was estimated from published formulas and checked by chest x-ray because manometric localization was not feasible, so reflux height classification may be imprecise. Symptoms were counted as associated with reflux if they occurred within 120 seconds, so temporal association does not prove reflux caused the symptom. Only 20% of acid reflux events were associated with at least one symptom, and 8% of symptoms were associated with acid reflux events, so reflux was not the obvious cause for many symptoms.

The article is marked as supported by NIH extramural research funding, and the authors reported no conflicts of interest.

Do not read the higher symptom association with proximal or middle reflux as proof that reflux caused the symptom or that acid suppression will help. Only 20% of acid reflux events were associated with at least one symptom, and this study did not test treatment.