PEDIATRICS Vol. 115 No. 4 April 2005, pp. 1110-1111 (doi:10.1542/peds.2004-2504)
The Natural Course of Infantile Reflux Regurgitation: A Non-Western Perspective
Seksit Osatakul, MDDepartment of Pediatrics
Prince of Songkla University
Hat-Yai, Songkhla 90110, Thailand
To the Editor.—
I read with interest the Pediatrics article "Functional Gastrointestinal Disorders in Children: An Italian Prospective Survey" by Miele et al.1 Their objective was to assess the prevalence and natural history of functional gastrointestinal disorders including infant regurgitation, cyclic vomiting syndrome, functional diarrhea, functional dyspepsia, irritable bowel syndrome, and functional constipation in children by using the Rome diagnostic criteria.2
The survey showed that the prevalence of reflux regurgitation (daily regurgitation of 
2 episodes per day with a duration of 3 weeks) was 7% in Italian infants. The mean age of affected infants was 3.8 ± 3.3 months. All infants had improvement in their symptoms at the 3-month follow-up evaluation; however, 84% still satisfied the Rome criteria for reflux regurgitation. By the 12-month follow-up, none had significant episodes of regurgitation. It is noted that 33% of the infants with regurgitation had been treated with thickened feeds and 11% with prokinetic agents.
Two years previously, we conducted a cohort study of the prevalence and natural course of gastroesophageal reflux (GER) symptoms in Thai infants.3 At 1 month of age, 33.1% of 145 Thai infants had daily regurgitation, with a mean number of 2.3 episodes per day. When following the reflux symptoms of these infants for 1 year, the prevalences of daily regurgitation markedly decreased to only 8.3% at 4 months, 2.1% at 6 months, and 0% at 10 to 12 months. No complications were found in these infants, and they were treated by reassuring the parents about the physiologic nature of the symptoms and advising them to avoid factors predisposing the infants to regurgitation.
When comparing our data with those of Miele et al, some interesting points are noted. The prevalences of reflux regurgitation in infants 
3 months old in the 2 studies are similar (7% in Italian infants vs 8.3% in Thai infants). However, at the 3-month follow-up evaluation, most Italian infants (84%) still had regurgitation that satisfied the Rome criteria, whereas most of our Thai infants had improvement in their symptoms as the prevalence of daily regurgitation decreased from 8.3% at 4 months of age to only 2% at 6 months and 0% at 10 months. By this comparison, it seems that the natural course of reflux regurgitation in Thai infants is shorter than in Italian infants. This difference is evident, although a considerable number of infants in the Miele et al study received various antiregurgitation treatments. Whether such differences in the natural course are related to differences in environmental factors or genetic background has yet to be determined.
Although regurgitation from GER is a common problem in infants, epidemiologic data concerning the natural course of GER during infancy is limited, particularly concerning GER in non-Western infants. The objective of this letter is to present our data and to compare our findings with those of Miele et al, which used similar diagnostic criteria and study design. I believe that examining differences in the clinical course of infantile regurgitation between different ethnic groups as mentioned here will be beneficial for understanding the nature of GER in children in general.
REFERENCES
- Miele E, Simeone D, Marino A, et al. Functional gastrointestinal disorders in children: an Italian prospective survey.
Pediatrics. 2004;114
:73
–78
[Abstract/Free Full Text] - Rasquin-Weber A, Hyman PE, Cucchiara S, et al. Childhood functional gastrointestinal disorders. Gut. 1999;45(suppl 2) :II60 –II68
- Osatakul S, Sriplung H, Peutpaiboon A, Junjana C, Chamnongpakdi S. Prevalence and natural course of gastroesophageal reflux symptoms: a 1-year cohort study in Thai infants. J Pediatr Gastroenterol Nutr. 2002;34 :63 –67[CrossRef][Web of Science][Medline]
PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics
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