Does the size of nasogastric tubes affect gastroesophageal reflux in children?

Background: To evaluate the effects of nasogastric tube insertion and diffe rent nasogastric tube sizes on gastroesophageal reflux in children. Methods: During a prospective randomized study, 29 patients aged 1 month to 4 years (median, 9 months) underwent 24 hours of continuous esophageal pH monitoring to rule out gastroesophageal reflux as the cause of severe pulmo nary problems. Each patient was monitored without nasogastric tube for 16 h ours (baseline), and thereafter the first nasogastric tube, small (8-Fr) or large (10-Fr or 12-Fr), was placed. Four hours later, the original nasogas tric tube was replaced by a new one of large (instead of small) size or of small (instead of large) size. We selected the times of wakefulness in thes e study periods and compared the number of reflux episodes (NREs), the numb er of reflux episodes that lasted more than 5 minutes (NRE > 5), and the pe rcentage of time with esophageal pH less than 4 (PTP < 4). Results: The 12-Fr group in comparison with the 8-Fr group and baseline sho wed significant difference (P < 0.05) in the NRE>S and PTP<4 parameters. No significant differences were found when comparing 8-Fr versus 10-Fr groups and baseline. In children with (n = 20) and without (n = 9) gastroesophage al reflux, comparison of the various reflux parameters between baseline and the different sizes of nasogastric tubes showed the same results. Conclusions: Size of the nasogastric tubes is a significant factor in predi sposing the child to gastroesophageal reflux. Large nasogastric tubes inter fere with the clearance of the refluxed acid from the esophagus.