Milk-Thickening Agents as a Treatment for Gastroesophageal Reflux

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Abstract
Milk thickening agents are believed to reduce episodes of gastroesophageal reflux, but their use has not been evaluated thoroughly. We studied the effect of these agents in 30 bottle-fed babies, 6-8 weeks old, with clinical gastroesophageal reflux pathology. Continuous 24-hour esophageal pH monitoring revealed gastroesophageal reflux pathology for all parameters studied: reflux index (18.4%), duration of the longest reflux episode (23.3 min), number of reflux episodes in 24 h (34.5), number of reflux episodes > 5 min (6.8). All investigations were performed in prone-anti-Trendelenburg position. The infants were treated with milk thickening agents (1 g to 115 ml, as recommended by Carre). Most (n = 25) showed clinical improvement of their symptoms. A second pH monitoring was performed under treatment conditions after 7-14 days, and showed in 24 infants a decrease of the number of reflux episodes (15.1 in 24 h) (p < 0.001), but a comparable reflux index (17.8%) (NS) and number of long lasting (>5 min) reflux episodes (7.8) (NS). The duration of the longest reflux episode, however, increased significantly (56.6 min) (p < 0.001). In six infants all parameters were within normal ranges at follow-up. Milk thickening agents seem clinically effective as a treatment for gastroesophageal reflux in individual cases, but can lead to occult gastroesophageal reflux episodes of long duration, possibly increasing the risk for esophagitis or respiratory dysfunction.

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