Multicenter registry of pediatric inflammatory bowel disease from a developing country.

BACKGROUND: Despite the rising incidence of pediatric inflammatory bowel disease (PIBD) globally, multicenter collaborative studies of PIBD children among developing countries remain sparse. We therefore aimed to define the initial presentation and short-term outcomes of Thai children with PIBD from a multicenter registry. METHODS: Four teaching hospitals participated in this study. A diagnosis of PIBD requires gastrointestinal endoscopy and histopathology in children aged < 19 years. Besides demographics, we collected clinical information and treatment with the data at 1-year follow up. RESULTS: We included 35 Crohn's disease (CD), one IBD-unclassified, and 36 ulcerative colitis (UC) children (total n = 72 with 60.6% males). The mean age at diagnosis was 7.9 years (SD 4.1) with 38% being very early onset IBD (VEO-IBD). When compared with UC, the CD children were more likely to exhibit fever (42.3 vs. 13.9%), weight loss/failure to thrive (68.6 vs. 33.3%), and hypoalbuminemia (62.9 vs. 36.1%) but less likely to have bloody stools (51.4 vs. 91.7%) (all P < 0.05). No significant differences in demographics, clinical data and medications used with regards to VEO-IBD status. At 1 year after diagnosis (n = 62), 30.7% failed to enter clinical remission and 43.7% remained on systemic corticosteroids. Diarrhea (OR 9.32) and weight issues (OR 4.92) at presentation were independent predictors of failure to enter clinical remission; and females (OR 3.08) and CD (vs. UC) (OR 3.03) were predictors of corticosteroids use at 1-year follow-up. CONCLUSIONS: A high proportion of VEOIBD is noted, and CD was more likely to present with significant inflammatory burden. Diarrhea and weight issues at presentation were independent predictors of failure to enter clinical remission; and females and CD (vs. UC) were predictors of corticosteroids use at 1-year follow-up.

The magnitude and management of functional constipation at pediatric gastroenterology clinics: A survey study of various countries.

BACKGROUND AND AIM: There have been no large-scale epidemiological study of functional constipation of pediatric gastroenterology services. This survey was undertaken to investigate the prevalence of functional constipation and magnitude of related problems in hospital settings of various countries as well as the practice of pediatric gastroenterologists in management of these conditions. METHODS: The survey was conducted by sending questionnaires to members of Societies for Pediatric Gastroenterology Hepatology and Nutrition of various continents. RESULTS: A total of 274 pediatric gastroenterologists from 41 countries participated in this study. Functional constipation accounted for overall 30% of patients attending pediatric gastroenterology outpatient clinics. In comparison with non-western countries, respondents from western countries reported significantly higher median annual numbers of new patients with intractable functional constipation (10 [4,25] vs 5 [2,10], P < 0.001), dyssynergic defecation (3 [0,15] vs 1 [0,4], P < 0.001), and colonic inertia (2 [0,5] vs 0 [0,1], P < 0.001). The use of high dose polyethylene glycol for fecal disimpaction was significantly more commonly among respondents from western countries, whereas rectal enema was significantly more favored in non-western countries. Respondents from different continents reported significant discrepancies in choices of investigations and management of patients with dyssynergic defecation and colonic inertia. CONCLUSIONS: Functional constipation is a major problem for pediatric gastroenterology outpatient services worldwide. There were significant variations in the investigations of choice and therapeutic management of functional constipation, intractable functional constipation, and related problems among pediatric gastroenterologists of different geographic regions.

Clinical Outcomes of Children Diagnosed Dengue-Associated Acute Liver Failure with or without N-Acetylcysteine Treatment: A Retrospective Cohort Study.

OBJECTIVES: N-acetylcysteine (NAC) has been shown to prevent hepatic damage and improve microcirculatory blood flow and oxygen delivery to the tissue. Previous studies have proposed the benefit of NAC in dengue-associated acute liver failure (ALF). However, most studies are descriptive and lack comparison between groups. We aimed to compare the ALF resolution rate and mortality rate of those who received and did not receive NAC treatment. METHODS: A retrospective cohort study was conducted among children aged <15 years who were diagnosed with dengue-associated ALF at a tertiary hospital in Thailand, between January 2002 and July 2019. Demographic and clinical information were collected. Main outcomes were ALF resolution and mortality rate. RESULTS: Thirty-three patients were included of which 16 received NAC treatment (48.5%). Mean ages were 8.5 years (SD 3.7) and mean onset of ALF was 6.3 days (SD 1.6) after onset of fever. The grading of hepatic encephalopathy (HE) and organ failure was not significantly different between the two groups. In the NAC group, 13/16 children were prescribed 100 mg/kg/day of NAC until INR <2 without HE or <1.5 with HE. NAC was initiated 1.1 days (SD 0.3) after the ALF diagnosis. The NAC group showed a higher rate of ALF resolution (75% vs. 53% in the non-NAC group, p = 0.34) with a lower mortality rate (31% vs. 53%, p = 0.36). Side effects of NAC were not found. CONCLUSION: NAC may be beneficial in dengue-associated pediatric ALF. Further well-designed randomized control trials should be carried out.

The Brussels Infant and Toddler Stool Scale: A Study on Interobserver Reliability.

OBJECTIVES: The Bristol Stool Form Scale (BSFS) is inadequate for non-toilet trained children. The Brussels Infant and Toddler Stool Scale (BITSS) was developed, consisting of 7 photographs of diapers containing stools of infants and toddlers. We aimed to evaluate interobserver reliability of stool consistency assessment among parents, nurses, and medical doctors (MDs) using the BITSS. METHODS: In this multicenter cross-sectional study (2016-2017), BITSS photographs were rated according to the BSFS. The reliability of the BITSS was evaluated using the overall proportion of perfect agreement and the linearly weighted κ statistic. RESULTS: A total of 2462 observers participated: 1181 parents (48.0%), 624 nurses (25.3%), and 657 MDs (26.7%). The best-performing BITSS photographs corresponded with BSFS type 7 (87.5%) and type 4 (87.6%), followed by the BITSS photographs representing BSFS type 6 (75.0%), BSFS type 5 (68.0%), BSFS type 1 (64.8%), and BSFS type 3 (64.6%). The weakest performing BITSS photograph corresponded with BSFS type 2 (49.7%). The overall weighted κ-value was 0.72 (95% CI 0.59-0.85; good agreement). Based on these results, photographs were categorized per stool group as hard (BSFS type 1-3), formed (BSFS type 4), loose (BSFS types 5 and 6), or watery (BSFS type 7) stools. According to this new categorization system, correct allocation for each photograph ranged from 83 to 96% (average: 90%). The overall proportion of correct allocations was 72.8%. CONCLUSIONS: BITSS showed good agreement with BSFS. Using the newly categorized BITSS photographs, the BITSS is reliable for the assessment of stools of non-toilet trained children in clinical practice and research. A multilanguage translated version of the BITSS can be downloaded at https://bitss-stoolscale.com/.

An Electronic Questionnaire Survey Evaluating the Perceived Prevalence and Practices of Lactose Intolerance in 1 to 5 Year Old Children in South East Asia.

PURPOSE: Lactose intolerance (LI) is perceived to be frequent in Asia and has been reported to have considerable impact on dietary intake, nutritional status and the quality of life. We aimed to gather information from healthcare professionals on the perceived incidence, diagnosis and management of LI in 1 to 5 year old children in Southeast Asia. METHODS: An anonymous electronic survey was sent randomly among healthcare professionals registered in the database of the pediatric societies in Thailand, Indonesia, and Singapore between June and October 2016. RESULTS: In total, 259 health care professionals responded of which 45.5% (n=118) were from Thailand, 37.4% (n=97) from Indonesia and 16.9% (n=44) from Singapore. Of the participants who responded (n=248), primary LI prevalence among children 1 to 3 years of age was estimated to be less than 5% by 56.8%. However, about 18.9% (n=47) answered they did not know/unsure. Regarding secondary LI, 61.6% of respondents (n=153) estimated the prevalence to be less than 15%. But again, 10.8% (n=27) answered they did not know or unsure. Rotavirus gastroenteritis was ranked as the top cause for secondary LI. There was considerable heterogeneity in the diagnostic methods used. The majority of respondents (75%) recommended lactose-free milk to manage primary and secondary LI. CONCLUSION: More education/training of pediatricians on this topic and further epidemiological studies using a more systematic approach are required.

Laxative Choice and Treatment Outcomes in Childhood Constipation: Clinical Data in a Longitudinal Retrospective Study.

PURPOSE: Functional constipation (FC) is a common gastrointestinal (GI) problem affecting children's well-being and quality of life. Although polyethylene glycol (PEG) is recommended as the first line therapy, it is not always applicable in lower socioeconomic populations. Hence, this study aimed to compare clinical courses of FC in children treated with different medications in order to identify prognostic factors related to treatment outcomes. METHODS: We reviewed the medical records of patients aged ≤15 years diagnosed with FC according to the Rome IV criteria from 2007 to 2015 at the GI clinic, Songklanagarind Hospital. Baseline characteristic, medical history, and treatment outcomes were collected at first and subsequent visits. RESULTS: Exactly 104 patients (median age at diagnosis, 2.8 years) were diagnosed with FC. The number of follow-up visits per patient ranged from 1 to 35. The median duration of follow-up was 18.0 months (range, 6.0-84.2 months). PEG was given to 21% of patients. During the follow up period, 76% of patients experienced first recovery with a median time to recovery of 9.8 months. There were no significant differences in time until first recovery and relapse between patients who received and those who did not receive PEG (p=0.99 and 0.06, respectively). Age >6 years, normal defecation frequency, no history of cow's milk protein allergy, and use of laxatives were associated with successful outcomes. CONCLUSION: Treatment outcomes between patients who had and never had PEG demonstrated no significant difference in our study. Hence, current practices in laxative prescriptive patterns may be effective.

Prevalence, cause and diagnosis of lactose intolerance in children aged 1-5 years: a systematic review of 1995-2015 literature.

BACKGROUND AND OBJECTIVES: To assess the prevalence, etiology, diagnosis of primary and secondary lactose intolerance (LI), including age of onset, among children 1-5 years of age. Suspected/perceived lactose intolerance can lead to dietary restrictions which may increase risk of future health issues. METHODS AND STUDY DESIGN: MEDLINE, CAB Abstract, and Embase were searched for articles published from January 1995-June 2015 related to lactose intolerance in young children. Authors independently screened titles/abstracts, full text articles, for eligibility against a priori inclusion/exclusion criteria. Two reviewers extracted data and assessed quality of the included studies. RESULTS: The search identified 579 articles; 20 studies, the majority of which were crosssectional, were included in the qualitative synthesis. Few studies reported prevalence of primary LI in children aged 1-5 years; those that did reported a range between 0-17.9%. Prevalence of secondary LI was 0-19%. Hydrogen breath test was the most common method used to diagnose LI. None of the included studies reported age of onset of primary LI. CONCLUSIONS: There is limited recent evidence on the prevalence of LI in this age group. The low number of studies and wide range of methodologies used to diagnose LI means that comparison and interpretation, particularly of geographical trends, is compromised. Current understanding appears to rely on data generated in the 1960/70s, with varied qualities of evidence. New, high quality studies are necessary to understand the true prevalence of LI. This review is registered with the International Prospective Register for Systematic Reviews (PROSPERO).

Development of the Brussels Infant and Toddler Stool Scale ('BITSS'): protocol of the study.

INTRODUCTION: The Bristol Stool Form Scale (BSS) which consists of 7 photographs of different stool forms allows assessment of stool consistency (scale 1 for hard lumps to scale 7 for watery stools), in an objective manner in adults. The BSS is also sometimes used to characterise the stools of infants and young children. Despite its use, there is general agreement among paediatric gastroenterologists that the BSS is not adequate to be used in infants and young children who wear diapers; thus, a new scale specifically designed for this population is needed. Our aim is to develop a paediatric stool scale, the Brussels Infant and Toddler Stool Scale ('BITSS'), and to evaluate the interobserver agreement of stool assessment with the BITSS between the patient's parent and healthcare providers (physicians and nurses). METHODS AND ANALYSIS: This study has two phases. In the first phase, 11 key-opinion leaders in the field of paediatric gastroenterology representing different areas of the world selected seven coloured photographs of infants and/or young children wearing diapers to match the original descriptors of the BSS. The selected photographs were used to create a new scale in which the drawings of stools of the BSS were replaced by infant/toddlers stool photographs. In phase II, we aim at demonstrating that parents, nurses and primary healthcare physicians interpret the stool-pictures of the BITSS with a high degree of consensus and that the agreement is independent of whether it is a parent or a healthcare provider. Interobserver variability of stool assessment with the BITSS between the patient's parent and healthcare providers will be assessed. ETHICS AND DISSEMINATION: The study will be approved by the Ethics Committee of the participating centres. The findings of this study will be submitted to a peer-reviewed journal. Abstracts will be submitted to national and international conferences. TRIAL REGISTRATION NUMBER: NCT02913950.

Influence of Body Position on Anorectal Manometric Assessment in Functional Constipation.

Objective: To date, there have been no studies to evaluate the influence of posture on anorectal manometric measurements in patients with functional constipation. The present study aimed to compare differences in anorectal manometric measurements in constipated patients when performing the test in the lying and sitting positions. Material and Method: Anorectal manometry with a conventional solid state manometric catheter was performed in 30 constipated patients in both the lying and sitting positions. Anorectal manometric variables at rest and during attempted defecation with empty rectum were assessed in both positions. A colonic transit study using Sitzmarks radiopaque markers and a 50-mL water-filled balloon expulsion test was also performed in all patients. Patients exhibiting an abnormal manometric pattern of defecation in either the sitting or lying position proceeded to a simulated defecation test. The anorectal pressure parameters of resting and during attempted defecation of the both positions were compared. Results: The resting rectal pressure, maximum rectal straining pressure, and defecation index during attempted defecation were significantly higher in the sitting position than the lying position. A dyssynergic manometric pattern during attempted defecation with empty rectum was seen in 46% of the patients in the lying position, not significantly different from the 56% in the seated position (p = 0.58). Most patients (71%) who exhibited manometric dyssynergia with an empty rectum could relax their anal sphincter during the simulated defecation test. Only six (20%) constipated patients had abnormal dyssynergic anal sphincter contraction confirmed by a simulated defecation test. Conclusion: Body position affects the results of manometric measurements related to the defecation mechanism.

Prevalence and Health Outcomes of Functional Gastrointestinal Symptoms in Infants From Birth to 12 Months of Age.

OBJECTIVES: The aim of the study was to review published evidence and the opinion of practising clinicians on the prevalence and long-term health consequences of functional gastrointestinal symptoms in infants younger than 12 months. METHODS: PubMed was searched from inception to November 2014 to find articles reporting the prevalence and long-term health outcomes of infantile colic, regurgitation, functional constipation, functional diarrhoea, and dyschezia in infants younger than <12 months. A questionnaire was sent to practising clinicians worldwide, and a group of 15 international experts met to discuss the likely frequency and longer-term consequences of these symptoms. RESULTS: The literature search identified 30 studies reporting the prevalence of infantile colic (2%-73%), 13 that of regurgitation (3%-87%), 8 that of functional constipation (0.05%-39.3%), 2 that of functional diarrhoea (2%-4.1%), and 3 that of dyschezia (0.9%-5.6%). The studies varied in design, populations investigated, and definition of the symptoms. Questionnaires were received from 369 respondents. The experts agreed that the likely prevalences for colic, regurgitation, and functional constipation were 20%, 30%, and 15%, respectively. The limited data in the literature for functional diarrhoea and dyschezia suggest prevalences <10%. Infantile colic may be associated with future health problems in a subset of infants. CONCLUSIONS: Functional gastrointestinal symptoms appear to occur in a significant proportion of infants younger than 12 months and may have an impact on future health outcomes. Prospective collection of data according to agreed criteria is needed to obtain more accurate estimates of the prevalence and consequences of these symptoms.

Recurrences of visceral leishmaniasis caused by Leishmania siamensis after treatment with amphotericin B in a seronegative child.

We report the first case of visceral leishmaniasis caused by Leishmania siamensis in a seronegative child. She was treated with amphotericin B at 1 mg/kg/day for 3 weeks; however, recurrences occurred twice. The patient was cured after the administration of amphotericin B for 5 weeks and monthly prophylaxis for 6 months.

Use of Rome II versus Rome III criteria for diagnosis of functional constipation in young children.

BACKGROUND: There has been no study to evaluate the use of the Rome III criteria for diagnosis of constipation in the unselected young pediatric population. The aim of this study was to evaluate and compare the use of the Rome II and Rome III criteria for diagnosis of constipation in a group of unselected young Thai children. METHODS: This cross-sectional study was conducted in 3010 healthy children aged 4 months-5 years who attended a well-baby clinic. Data concerning bowel habits and behavioral components of defecation of the children were obtained by interviewing the parents. Presence of a large fecal mass in the rectum of children with possible constipation was evaluated by abdominal palpation. RESULTS: Seventy-one children (2.4%) were found to have constipation, based on at least one of the two sets of criteria, at the time of interview. The prevalence of constipation as defined according to the Rome II and Rome III criteria for functional constipation (FC) was 1.9% and 1.6%, respectively. The majority of constipated children (47.9%) met the diagnostic criteria of both the Rome II and Rome III for FC, followed by the Rome II criteria for FC alone (32.4%) and the Rome III criteria for FC alone (18.3%). Twenty-one children (0.7%) whose parents reported defecation difficulties did not fulfill any diagnostic criteria for constipation. CONCLUSIONS: The prevalence of FC in young Thai children is low. For unselected young children, the Rome II criteria for FC are still appropriate for diagnosis of FC.

Multilocus characterization and phylogenetic analysis of Leishmania siamensis isolated from autochthonous visceral leishmaniasis cases, southern Thailand.

BACKGROUND: Visceral leishmaniasis (VL) caused by Leishmania siamensis is an emerging disease continuously reported in six southern provinces of Thailand. To date, the phylogenetic relationships among Leishmania isolates from Thai patients and other Leishmania species are still unclear and the taxonomic diversity needs to be established. In this study, the phylogenetic inference trees were constructed based on four genetic loci (i.e., SSU-rRNA, ITS1, hsp70, and cyt b), using DNA sequences obtained from autochthonous VL patients from southern Thailand and reference sequences of reported Leishmania isolates from other studies deposited in GenBank. RESULTS: Phylogenetic analyses of hsp70 and cyt b loci supported a clade comprised of L. siamensis isolates, which is independent to the other members in the genus Leishmania. In combination with genetic distance analysis, sequence polymorphisms were observed among L. siamensis isolates and two different lineages could be differentiated, lineages PG and TR. Phylogenetic analysis of the cyt b gene further showed that L. siamensis lineage TR is closely related to L. enrietti, a parasite of guinea pigs. CONCLUSION: The finding of this study sheds further light on the relationships of L. siamensis, both in intra- and inter-species aspects. This information would be useful for further in-depth studies on the biological properties of this important parasite.

Lipoprotein(a) and the risk of thromboembolism in Thai children.

High lipoprotein(a) [Lp(a)] level was identified as a risk factor of both venous and arterial thromboembolism (TE), especially in Caucasian children. The Lp(a) level is affected by apo(a) gene. The genetic polymorphisms that associated with Lp(a) level are the size of apo(a) gene, pentanucleotide repeat (TTTTA)(n) and +93C/T at promoter region. The increasing size of apo(a) gene, more than 8 pentanucleotide repeats and +93C>T polymorphisms are associated with low level of Lp(a) in African and Caucasian populations. This cross - sectional, case control study, aims to identify the association of Lp(a) level and the risk for TE in Thai children. Forty-nine patients and 116 healthy children were enrolled. Mean ± SD for age of patients and controls were 7.6 ± 4.7 and 11.2 ± 1.7 years, with female:male ratios of 1:1.2 and 1.8:1, respectively. The median Lp(a) levels in patients was 8.2 (0-87.3) mg/dL and 7.9 (0-74.9) mg/dL in controls, which were not statistically different, P=0.65. The frequencies of 8 pentanucleotide repeats and +93C/T were different compared to Caucasian and African populations but similar to Chinese population. However, both polymorphisms did not affect the level of Lp(a).

Appropriate use of empirical antibiotics in acute diarrhoea: a cross-sectional survey in southern Thailand.

BACKGROUND: Although treatment with empirical antibiotics is recommended for dysenteric or invasive bacterial diarrhoea, overuse is common in clinical practice worldwide. Recent information on the use of antibiotics in Thai children with acute diarrhoea is lacking. OBJECTIVE: To survey the appropriate use of empirical antibiotics in children with acute diarrhoea in hospitals in southern Thailand and evaluate the association between their use and clinical features. METHODS: Outpatient medical records of children aged 2 months to 5 years with acute diarrhoea seen at ten hospitals in southern Thailand (five community and five general hospitals) during January to December 2004 were reviewed. Children with diarrhoeal symptoms lasting >7 days, who were immunocompromised, who had an underlying disease or whose medical records were inadequate were excluded. Appropriate use of empirical antibiotics was defined as: use of an antibiotic in a child with a history of bloody-mucous diarrhoea, who had a faecal WBC count of >10 cells/HPF, or no prescription of antibiotics in watery, non-bloody diarrhoea. RESULTS: There were 2882 patient encounters, 70% of which were children under 2 years of age. Invasive bacterial diarrhoea comprised 6.9% of the total number of cases. Of the 2882 patient encounters, 50.3%, 36.4% and 13.3% were seen by general practitioners, paediatricians or other medical personnel, respectively. Antibiotics had been used appropriately in 44.1% of cases. Of the 55.9% of cases identified as inappropriate use, 55.2% involved unnecessary antibiotic prescriptions in non-indicated cases. The prevalence of appropriate use was significantly higher in general hospitals than in community hospitals (51% vs 37.1%, p<0.05). Medical trainees were more likely to prescribe antibiotics more appropriately than staff physicians (76.9% vs 44.2%, p<0.05). Multivariate analysis showed that a history of fever (OR 1.25, 95% CI 1.04-1.50), watery-mucous stool (OR 2.54, 95% CI 1.94-3.32), mushy-mucous stool (OR 2.62, 95% CI 1.28-5.35), bloody-mucous stool (OR 6.97, 95% CI 4.17-11.64), stool frequency of 5-10 times/day (OR 1.41, 95% CI 1.16-1.70), body temperature 38.6-39.5 degrees C (OR 1.86, 95% CI 1.17-2.98) and a faecal WBC count of even 1-10 cells/HPF (OR 3.24, 95% CI 1.55-6.77) were associated with antibiotic use. CONCLUSION: Overuse of antibiotics in the treatment of acute diarrhoea in children is common. The prevalence differs between different levels of hospitals and different types of medical personnel. Physicians might mistake some patients' clinical features of diarrhoea as features of dysentery, leading to unnecessary prescription of antibiotics.

Peri-operative factors predicting the outcome of hepatic porto-enterostomy in infants with biliary atresia.

INTRODUCTION: Without hepatic transplantation, hepatic porto-enterostomy is the only definitive surgical therapy for infants with biliary atresia. Unfortunately, clearance of jaundice by the procedure is not promising. Pre-operative data that may predict the outcome is of great value in the selection of surgical candidates. Early post-operative determinants of outcome also help in follow-up planning. OBJECTIVE: To determine peri-operative factors influencing jaundice clearance after hepatic porto-enterostomy in infants with biliary atresia. PATIENTS AND METHOD: Clinical and laboratory data of pediatric patients undergoing hepatic porto-enterostomy in Songklanagarind Hospital from 1988 to 2001 were reviewed regarding age at operation, clinical presentation, gross pathology of bile duct atresia, liver function profiles and changes after the procedure, liver pathology and post-operative ascending cholangitis. Univariate comparison followed by multivariate logistic regression analysis was analyzed against the clearance of jaundice. Statistical analysis was aided by the Stata 7.0 program. Statistical significance was set at p-value less than 0.05. RESULTS: There were 62 infants operated on during the thirteen-year period. Four cases of operative death and a case lost to follow-up before the second post-operative month was excluded. The median age at the operation was 78 days (34-326 days). Twenty-four cases (42.1%) presented with signs of portal hypertension. After the operation, 19 cases (33.4%) were jaundice free, 6 cases (10.5%) had fair clearance and 32 cases (56.1%) had a poor result. Univariate analysis revealed an association between age at surgery and jaundice clearance. Post-operative stool color and decline of total bilirubin level at one month after surgery were significantly correlated with the outcome (p < 0.01). Cholangitis within the first post-operative month significantly had an adverse effect on the short-term survival probability. Multivariate analysis showed an independent association of jaundice clearance with age at surgery and type of bile duct atresia. CONCLUSION: Age of the infants younger than 60 days and type I of bile duct atresia were the key determinants of successful hepatic porto-enterostomy. Early cholangitis was an accelerator of progressive cirrhosis. Stool color and bilirubin level at one month after surgery can be used as predictors of jaundice clearance.

Prevalence and natural course of gastroesophageal reflux symptoms: a 1-year cohort study in Thai infants.

BACKGROUND: Epidemiologic studies in adults suggest that the nature of gastroesophageal reflux may differ among various ethnic groups. Until recently, there has been limited information concerning the epidemiology of gastroesophageal reflux in non-Western children. The objectives of this cohort study were to investigate the prevalence of symptoms related to gastroesophageal reflux in Thai infants and to describe the clinical course of reflux regurgitation during the first year of life. METHODS: A cohort study was performed in 216 healthy neonates who attended the well-baby clinic of Songklanagarind Hospital between March and June 1998. All neonates were followed up, at regular well-baby clinic visits, for 1 year for reflux symptoms and clinical progress. Information concerning gastroesophageal reflux symptoms was obtained by interviewing the parents and from their diary records. An infant who regurgitated at least 1 day per week was considered to have reflux regurgitation. RESULTS: No infant with clinical features of pathologic gastroesophageal reflux or other reflux symptoms apart from regurgitation were seen during this study period. Of 145 infants in a 1-year cohort, the prevalence of reflux regurgitation peaked at 2 months at 86.9% and significantly decreased to 69.7% at 4 months, 45.5% at 6 months, and 22.8% at 8 months. At 1 year of age, only 7.6% of infants still had reflux regurgitation. Most Thai infants with gastroesophageal reflux had mild symptoms: 90% of them regurgitated only one to three times per day, and daily regurgitation was reported in a low percentage. Comparing infants with reflux regurgitation and those without, the standard deviation scores of body weight for age were similar. There was no significant difference in prevalence of reflux regurgitation between breast-fed and bottle-fed infants. CONCLUSIONS: The nature of gastroesophageal reflux in Thai infants differs from that in Western infants. The prevalence of reflux regurgitation in Thai infants was very high at 1 to 2 months of age; however, many infants became symptom-free by 6 months. The type of feeding (breast milk vs. bottle milk) had no influence on the prevalence of reflux regurgitation.