Evaluation of Smectite Effect as a Food Thickener in Gastroesophageal Reflux Disease in Neonates Using Combined Esophageal Multichannel Intraluminal Impedance

Gastroesophageal reflux disease (GERD) occurs when reflux of the gastric contents causes symptoms, MII-pH offer several advantages over the traditional diagnostic measures as it detects reflux regardless of its pH and distinguishes swallows from GER. Thickening of infant formulas has been recommended for the treatment of GERD. Agents that have been used include cereal, rice, bean gum, sodium carboxymethyl cellulose, pectin, cellulose and carobel. We aimed to assess the efficacy of (Smectite) as a food thickener in treating GERD in neonates using MII-pH before and after Smectite. Twenty preterm neonates ≤ 36 weeks of age from maternity hospital, Ain Shams University, enrolled during the period 2018 to 2020, all had signs suggestive of GERD, Feeding intolerance, and repeated chest infections due to frequent apneas, aspiration or associated with bronchopulmonary dysplasia as well as nonspecific behavioral signs including arching, irritability, and apparent discomfort associated with feedings, GERD was confirmed by MII-pH for 24hrs. Diagnosis of reflux was done by total number of liquid and mixed Reflux > 100 as per (1) López-Alonso et al., 2006. patients then were prescribed Smectite (3 g/day for 7 days). On the 8th day, a second 24-hour MII-pH was performed to assess the response. Preterm infants with more than 100 impedance events were diagnosed with GERD most of these attacks were non acidic and weakly acidic attacks. Using Smectite as a food thickener was followed by a significant decrease in total reflux time and total frequency of reflux episodes (P. value <0.001), there was also a significant decrease in the frequency of impedance events per 24hrs. Total frequency of reflux episodes before and after Smectite decreased in terms of number of signs related to reflux before and after treatment such as vomiting, acute life threatening events like bradycardia, apnea, wheezy chest, desaturations all of which improved significantly after treatment. MII-pH is one of the most sensitive tools for the diagnosis of reflux and Smectite could be used as a feed thickener to decrease reflux signs and symptoms for more studies on a larger scale to confirm.