ESOPHAGITIS AND MODIFIED BERNSTEIN TESTS IN INFANTS WITH APPARENT LIFE-THREATENING EVENTS

Objective. The current study was undertaken to determine the prevalenc e of abnormal intraesophageal pH monitoring, esophagitis, and oxygen d esaturation after experimental esophageal acidification (modified Bern stein test) in patients with apparent life-threatening events (ALTEs). Methods. Fifty patients admitted to the hospital with ALTEs were eval uated. Patients underwent 24-hour intraesophageal pH monitoring, esoph ageal Suction biopsies, and modified Bernstein tests to document oxyge n desaturation during experimental esophageal acidification. Results. Abnormal pH monitoring was present in 82%, esophagitis in 16%, and oxy gen desaturation of at least 5% with experimental esophageal acidifica tion in 22% of the patients. Esophagitis was present in only 3 of 11 p atients with oxygen desaturation, which was not different from those p atients without oxygen desaturation. Clinical history was not predicti ve of oxygen desaturation during experimental acidification except tha t patients with a history of an ALTE while awake were more likely to d emonstrate oxygen desaturation with acid. Conclusion. We conclude that 1) the prevalence of oxygen desaturation with experimental acidificat ion in infants with ALTEs is significant and warrants further evaluati on; 2) esophagitis is not a necessary predisposing condition to esopha geal acid sensitivity in infants with ALTEs; and 3) ALTEs while awake are frequently associated with a positive modified Bernstein test.