Incidence of Gastroesophageal Reflux During Transpyloric Feeds

Objectives: Transpyloric feeding has been proposed as an alternative method for controlling gastroesophageal reflux, but there have been no pediatric studies to determine how transpyloric feeding affects reflux burden. The aim of the present study was to determine the reflux burden in patients receiving transpyloric feeds. Patients and Methods: We reviewed the multichannel intraluminal impedance tracings of patients who had persistent symptoms and were fed transpylorically during the multichannel intraluminal impedance recording. We compared the reflux profiles during feed and nonfeed periods. We also compared the number of reflux-related hospitalizations at Children's Hospital Boston in the year before and the year after the initiation of transpyloric feeds. Results: The mean number of reflux events per hour was 1.4 +/- 1.3 and 0.8 +/- 1.1 during feed and nonfeed periods, respectively (P = 0.06). There was no significant difference in the percentage of time that boluses were present in the esophagus during feed periods (1.0% + 1.4%) compared with the nonfeed periods (0.6% +/- 1.1%, P = 0.5). There was no significant difference in the mean number of reflux-related hospitalizations in the year before (1.2 +/- 1.4) or after (1.4 +/- 1.2, P = 0.7) the initiation of transpyloric feeds. Conclusions: There is more reflux during transpyloric feeding periods than nonfeeding periods, which may explain why some patients continue to have reflux-related hospitalizations even after the initiation of transpyloric feeds.