Comparison of direct effects of rice-thickened formula vs. routine feeds on symptoms and gastroesophageal reflux indices: A crossover cohort study
Abstract
BACKGROUND
We compared the direct effects of routine vs rice-thickened formula on 24-hour pH-impedance and symptom characteristics, and then examined if dietary effects were modified by acid reflux index severity in infants.
METHODS
Forty infants under consideration for gastroesophageal reflux disease and therapies were evaluated at 43 ± 1 weeks postmenstrual age. Each infant was equally fed routine diet and thickened formula during evaluations. Post-prandial sessions were analyzed for acid reflux index, reflux events, clearance times, distal baseline impedance, and symptoms.
RESULTS
Thickened formula has no effect (p ≥0.05) on acid reflux events characteristics or overall symptom frequency. However, refluxate height, and frequency of weakly acid events and cough were decreased (p 7 (p <0.05).
CONCLUSIONS
Our pH-impedance testing protocol identifies direct effects of potential therapies at the point of care. Acutely, thickened formula does not impact acid-specific reflux indices but decreases full-column reflux and cough reflexes. In those with acid reflux index >7, thickened formula prolongs the distal esophageal bolus clearance, the mechanisms of which are uncertain. Clinical trials are needed to clarify objective indications and therapeutic use of thickened formulas for infants with gastroesophageal reflux disease along with short- and long-term side effects. This article is protected by copyright. All rights reserved.
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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