PEDIATRICS Vol. 115 No. 4 April 2005, pp. 1111 (doi:10.1542/peds.2005-0037)
The Natural Course of Infantile Reflux Regurgitation: A Non-Western Perspective: In Reply
Erasmo Miele, MDAnnamaria Staiano, MD
Department of Pediatrics
University of Naples "Federico II"
80131 Naples, Italy
We thank Dr Osatakul for his thoughtful comments. By the comparison of our and his data, it seems that the natural course of infant regurgitation, diagnosed on the basis of the Rome diagnostic criteria,1 in Italian infants is slightly different from that in Thai subjects. In fact, this functional disorder seems to persist in Italian subjects for a longer time during the 1-year follow-up despite a larger use of antiregurgitation drugs. The reasons for these differences are not known, but they may indicate both genetic and environmental factors peculiar to these particular racial groups. As suggested by Osatakul et al,2 the variation in gastroesophageal reflux (GER)-related genomes could play a role in the differences in epidemiology among different groups. Recent reports have suggested that both pediatric and adult-onset GER have major genetic components.3,4 In a recent study, a clear relationship between maternal symptoms of GER and symptoms of spilling in infancy and middle-childhood GER has been found, suggesting that genetic factors are important in milder GER.4 In addition, in adult Chinese subjects, it has been demonstrated that most of the factors involved in the pathogenesis of GER disease, previously described in Western studies, are present but at lower scale.5 The acidity of gastric contents is reduced spontaneously or by Helicobacter pylori infection. A low-fat diet contributes to a more favorable gastric distribution of the meals and reduced obesity and lowers the number of transient lower esophageal relaxations. The prevalence of hiatal hernia is low and esophageal motility disorders are moderate. Some of these factors could be responsible for the differences in the prevalence and in the natural course of the infant regurgitation in Western and non-Western infants as well. In conclusion, the role of several interesting and important factors needs to be clarified with additional cross-cultural genetic and environmental studies.
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PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics
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