Nine in 10 infants with reflux are incorrectly diagnosed, study finds

Only 10% of infants who showed symptoms of gastroesophageal reflux actually had it—which means that the remaining 90% were likely being over treated, according to a study published in the April 2016 issue of the Journal of Pediatric Gastroenterology & Nutrition.

Reflux in infants is usually diagnosed by only signs and symptoms, such as persistent vomiting, irritability, arching the back, apnea, bradycardia, oxygen desaturation, coughing, gagging, and wheezing, the researchers noted.

“Since the baby can’t tell us what they are feeling, we use this association between the reflux event and these other symptoms and signs of discomfort to help diagnose reflux disease,” said the study’s senior author, Zubair H. Aghai, MD, Professor and Director of Neonatology Research at Thomas Jefferson University, in Philadelphia, PA.

But when researchers compared clinical symptoms to the gold-standard reflux test—multichannel intraluminal impedance (MII-pH)—they found that the actual number of infants with significant gastroesophageal reflux was low. Also, most of the symptoms that were suspicious for reflux didn’t correlate with actual reflux events.

“Our study demonstrates that these symptoms may not be associated with reflux and should not necessarily indicate treatment,” Dr. Aghai said.

For this retrospective study, the researchers gathered data on 58 infants, both preterm and full term. All of the infants had been referred for evaluation because of a high index of suspicion of reflux based on clinical symptoms. When the researchers tested the infants using MII-pH, they found that it detected gastroesophageal reflux in only 6 of them (10%).

This finding indicates that most infants currently diagnosed as having reflux are not being treated correctly. Treatment for reflux usually involves proton pump inhibitors, metoclopramide, or surgery to tighten the esophageal sphincter—all of which have risks for the infant.

“The study suggests that doctors who suspect infants of having [gastroesophageal reflux] should use the MII-pH to confirm the diagnosis before treating with medications or surgery,” Dr. Aghai said.

Unfortunately, the reason the test isn’t more common is that it can require advanced training and expertise that isn’t available at all institutions, he added.

Misdiagnosing gastroesophageal reflux in infants also overlooks the true cause of the condition. “When the MII-pH comes back negative, we have to do a better job of investigating the root causes of the symptoms we’re seeing,” Dr. Aghai said.