[Effects of respiratory physical therapy and nasopharyngeal suction on gastroesophageal reflux in infants less than a year of age, with or without abnormal reflux].

The purpose of this study was to analyse the effects on gastro-oesophageal reflux (GOR) of the different manipulations used during pulmonary physical therapy (nasal suctions, oropharyngeal suctions, acceleration of expiratory flow). 115 children less than 1 year old, were divided into two groups according to the results of oesophageal pH monitoring: 44 with and 61 without pathological GOR. Nasal suctions did not significantly increase GOR in children without pathological GOR. Oropharyngeal suctions increased GOR significantly more than nasal suctions (*p = 0.031). The technique of acceleration of expiratory flow, used in 35 degrees verticalized position and supine position, increased the index of reflux and the time with oesophageal pH below 4 in children with pathological GOR. However it did not increase reflux in normal children. The index of induced reflux in the whole population was increased in the horizontal position (4.81 +/- 0.88 reflux/hour) as compared with 35 degrees verticalized (2.92 +/- 0.79 reflux/hour). These oesophageal pH measurements confirm the clinical observations often made during physical therapy (vomiting, regurgitations, reflex cough). This statistical study suggests that one should take into account the adverse factor of GOR secondary to pulmonary physical therapy. It seems better to use nasal rather than oropharyngeal suctions and also to use the acceleration of expiratory flow technique in the 35 degrees verticalized rather than in the supine position, even more so if a pathological reflux does exist.