***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A controlled , prospect i ve comparison of the use of the infant seat versus prone , head-elevated positioning in a harness was undertaken in 15 infants with gastroesophageal reflux .  pH monitoring of the distal esophagus demonstrated less reflux in the harness than in the seat ( P less than 0.001 ) during 19 pairs of two-hour postpr and ial trials . This difference was the result of both fewer episodes ( P less than 0.001 ) and briefer episodes ( P less than 0.05 ) . Prone-elevated positioning in the harness described is superior to positioning in an infant seat in the treatment of gastroesophageal reflux in infants younger than 6 months Background Milk formulas enriched with water-soluble fibers are a first-line measure for infants with gastroesophageal reflux . However , it has been reported that these compounds could affect gastric emptying . The aim of this study was to evaluate the effects of these thickeners on gastric emptying time in infants with frequent regurgitation or vomiting . Methods Forty-seven infants , aged 1 to 12 months , with uncomplicated gastroesophageal reflux underwent two ultrasound evaluations of gastric emptying time after receiving either a st and ard formula or a formula enriched with 0.4 g galactomannan per 100 ml diluted milk .  Gastric emptying time was calculated by measuring the antrum area at baseline and at defined intervals over the next 3 hours . Results The gastric emptying time ( mean ± SD ) for the st and ard and the thickened formula was 136 ± 33 and 133 ± 34 minutes , respectively . There was no significant difference in the gastric emptying patterns of the two formulas . Gastric emptying time was longer after the st and ard formula in 15 of the 47 subjects , shorter in 15 of the 47 , and the same in 17 of the 47 . Conclusions The ingestion of a water-soluble fiber-enriched formula does not have any significant influence on the gastric emptying time of infants with frequent regurgitation or vomiting Gastro-oesophageal reflux ( GOR ) occurs mainly during postcibal ( PC ) periods . The duration of PC gastric acidity and the incidence of GOR were analysed in 11 asymptomatic premature infants .  GOR was studied during PC periods of 120 min and also during the following 120 min defined as fasting ( FT ) periods . These infants were subjected to simultaneous continuous gastric and oesophageal pH monitoring using a double-blind crossover technique . Two formulae with different fat contents ( 2.6 vs 3.6 g/100 ml ) and different carbohydrate concentrations ( 8.1 vs 7.3 g/100 ml ; malto-dextrin 2.8 vs 1.9 g/100 ml ) were given . Gastric acidity ( pH<4 ) in the PC periods lasted significantly ( P<0.001 ) longer ( 68 min±10 ) with the low fat/high malto-dextrin formula versus 43 min±11 with the high fat/low malto-dextrin  formula . Oesophageal pH monitoring data were within normal limits for the total investigation time in all infants . During PC periods acid GOR was detected more frequently in the group with a low fat formula . More PC GOR was recorded when the gastric acidity time was longer The effect of two different types of feedings on results of esophageal pH monitoring was prospect ively studied in 49 infants undergoing evaluation for gastro-esophageal reflux ( GER ) . Infants were r and omly assigned to receive either apple juice ( AJ ) or formula for the first feeding during extended pH monitoring ( EPM ) . Each infant received the alternate liquid for the second feeding . During the rest of the monitoring period , infants received formula feedings . The percentage of time that esophageal pH was less than 4.0 following both types of feedings and the percentage of time that pH was lower than 5.0 following formula feedings were determined . Following AJ feeding , the mean percentage of time pH was less than 4.0 was 43.8 % in contrast to 5.1 % following formula feeding . However , following formula feeding , pH was less than 5.0 35.7 % of time , similar to the percentage of time pH was less than 4.0 after AJ feeding . Ability to detect GER with short-term monitoring after the two feedings was compared to detection following extended monitoring . Detection of GER with short-term monitoring following AJ feeding correlated well with extended monitoring ( r = 0.67 ; p < 0.001 ) . There was a weaker , although significant , correlation between short-term monitoring following formula feeding using pH less than 5.0 as the reflux criterion and extended monitoring ( r = 0.3 ; p < 0.01 ) . We conclude that outpatient GER evaluation with intraesoph-ageal pH monitoring during a feeding interval following an AJ feeding may serve as an acceptable substitute for extended pH monitoring when it is not practical or desirable to admit the patient to the hospital ABSTRACT : To evaluate the effect of pacifier use ( non-nutritive sucking ) on  gastroesophageal reflux in infants , 48 infants younger than 6 months of age with pathologic reflux were prospect ively evaluated with pH probe . In each infant , parameters of reflux were blindly quantified during paired periods in a cross-over design when pacifier use was either encouraged or prohibited . To determine whether positioning was a factor in the effect of nonnutritive sucking on reflux , 24 of the infants were studied seated and 24 studied prone . Pacifier use significantly affected only the frequency of reflux episodes , increasing it in prone infants from 7.2 ± 1.1 to 12.8 ± 2.3 episodes/120 min postpr and ially ( p = 0.040 ) and decreasing it in seated infants , from 21.1 ± 3.1 to 14.8 ± 2.6 postpr and ially ( p = 0.003 ) and from 17.3 ± 4.8 to 5.9 ± 0.9 in the fasting period ( p = 0.035 ) . It did not significantly affect the clearance of reflux episodes or the total reflux time . These results suggest that infants with pathologic reflux frequency might best avoid pacifier use while in the beneficial prone position . When seated position is necessary , the pacifying effects of nonnutritive sucking may be useful in decreasing reflux events as well as in reducing crying behavior The effect of milk type on physiological , gastroesophageal reflux ( GER ) was studied in 37 breast-fed and 37 formula-fed , healthy , term neonates aged 2–8 days . The neonates were r and omly selected from the public maternity ward and studied for 4 h after their morning milk feed .  GER was recorded by a pH microelectrode placed 6 cm above the gastroesophageal junction and analyzed in the third and fourth postpr and ial hours . Sleep state was accurately defined from the electroencephalogram , electrooculogram , electromyogram , breathing , and behavioral observations . Movement was recorded from a piezo-electric transducer . In active sleep , the breast-fed neonates demonstrated GER episodes of significantly shorter duration than the formula-fed neonates . The means and 95 % confidence intervals ( CI ) were 3.0 ( 1.6,5.2 ) compared with 8.3 ( 5.0,13.3 ) min/h of active sleep respectively ( p < 0.05 ) . This could not be explained by greater milk volume or increased movement before or during reflux in formula-fed neonates . However , the lower median pH values for GER in breast-fed neonates , 2.0 versus 2.5 , were significantly different ( p < 0.05 ) . This difference may reflect more rapid gastric emptying . The lower esophageal pH is more likely to stimulate peristalsis and thus limit the duration of reflux ( shorter episodes ) , in the breast-fed neonates To identify the prevalence of reflux symptoms in normal infants , to characterize the diagnostic validity of a previously described 138-item Infant Gastroesophageal Reflux Question naire ( I-GERQ ) for separating normal infants from those with gastroesophageal reflux disease ( GERD ) , and to identify potentially provocative caretaking practice s , we administered the question naire to 100 infants attending a well-baby clinic ( normals ) and to 35 infants referred to the Gastroenterology Division for evaluation for GERD and testing positive on esophageal pH probe or biopsy ( GERD infants ) . Differences were analyzed by Chi-square , and odds ratios were defined . The diagnostic validity of a 25-point I-GERQ GERD score based on 11 items on the question naire was evaluated by calculating its sensitivity , specificity , and positive and negative predictive values . We found that normal infants had a high prevalence of reflux symptoms , such as daily regurgitation ( 40 % ) , respiratory symptoms , crying more than an hour a day ( 17 % ) , arching ( 10 % ) , or daily hiccups ( 36 % ) but that many symptoms were significantly more prevalent in the GERD than in the normal infants ( Chi-square P<.05 ) , and odds ratios were above 3 for nearly 20 items . The positive and negative predictive values for the 25-point I-GERQ score were 1.00 and .94-.98 , respectively . Environmental smoke exposure did not quite reach significance as a provocative factor for GERD . Although normal infants have a high prevalence of symptoms suggesting GERD , a simple question naire-based score is a valid diagnostic test with high positive and negative predictive values BACKGROUND & AIMS Treatment for gastroesophageal reflux may be ineffective in patients with an eosinophilic infiltration of the esophagus . The aim of this study was to investigate whether unremitting symptoms of gastroesophageal reflux and biopsy abnormalities of the esophagus may be associated with the ingestion of certain foods . METHODS Ten children previously diagnosed with gastroesophageal reflux by st and ard testing with long-st and ing symptoms ( median , 34.3 months ; range , 6 - 78 months ) despite st and ard antireflux therapies , including Nissen fundoplication in 6 patients , were fed the elemental formulas Neocate or Neocate-1-Plus ( Scientific Hospital Supplies Inc. , Gaithersburg , MD ) for a minimum of 6 weeks . Each child had repeat endoscopy followed by open food challenges . RESULTS While receiving the formulas , patients had either resolution ( n = 8) or improvement ( n = 2 ) of symptoms . On follow-up esophageal biopsy , the maximal intraepithelial eosinophil counts decreased significantly before ( median , 41 ; range , 15 - 100 ) to after ( median , 0.5 ; range , 0 - 22 ) the formula trial ( P = 0.005 ) . Other reactive epithelial changes of the esophageal mucosa also improved significantly . All patients redeveloped their previous symptoms on open food challenges . CONCLUSIONS Chronic gastrointestinal symptoms and histological changes of the esophagus unresponsive to st and ard treatments for gastroesophageal reflux were improved by the use of elemental formulas . Symptoms recurred when specific dietary proteins were reintroduced during open food challenges . The mechanism of these observations is unknown BACKGROUND Paediatricians are familiar with infants complaining of regurgitation and emesis from gastrooesophageal reflux . These subjects , usually growing satisfactorily and healthy , are affected by " functional " or " symptomatic " gastrooesophagel reflux and are treated with posture changes and thickened feedings . AIM To evaluate in infants with symptomatic gastrooesophageal reflux the effect of a new formula ( Nutrilon AR ) , containing carob flour/locus bean gum as a thickening agent ; both clinical features and oesophageal acid exposure were evaluated . PATIENTS Twenty-four infants ( age range : 5 - 11 months ; median age : 8 months ; 8 females ) presented at our Unit with a history of chronic postpr and ial regurgitation . METHODS During a 24-hour intraoesophageal pH test a traditional formula thickened with rice flour at a concentration of 5 % was alternated with the formula Nutrilon AR ; thereafter infants were r and omly allocated to receive , for two weeks , either a traditional thickened formula or the new formula , in addition to posture changes . RESULTS Intraoesophageal acid exposure was significantly lower in the periods following the new formula than after traditional formula ; at the end of the treatment period patients receiving the new formula had a more significant decrease of both symptomatic score and number of episodes of emesis than patients on traditional formula . CONCLUSIONS The new available formula , with the characteristics of a thickened meal , is better than a formula , traditionally thickened with added rice flour , in the conservative treatment of infants with symptomatic gastrooesophageal reflux To determine whether a new “ anti-regurgitation formula ” containing a bean gum preparation decreases the number of regurgitations and gastro-oesophageal reflux ( GOR ) , we studied 20 infants from 1 week to 4 months of age , referred for evaluation of regurgitation , in a double-blind prospect i ve study . The number of regurgitations decreased significantly in both the treatment group 
    Output:
    
Positioning at a 60 degree elevation in an infant seat was found to increase reflux compared with the prone position .
No significant difference was shown between the flat and head-elevated prone positions .
The impact of pacifier use on reflux frequency was equivocal and dependent on infant position .
The protein content of formula was not found to affect reflux .
Another study showed that if supplementing with dextrose 5 % water or dextrose 10 % water , the lower-osmolality fluid was associated with less reflux .
CONCLUSIONS Many conservative measures commonly used to treat GERD in infants have no proven efficacy .
Although thickened formulas do not appear to reduce measurable reflux , they may reduce vomiting .