Banyak kajian terakhir menunjukkan bahwa GER tidak sebagai penyebab apneu atau apparent life-treatening events (ALTE’s) pada sebagian besar bayi. Gejala klinis tersebut baru dipertimbangkan sebagai akibat GER, bila kejadiannya berulang dan dibuktikan dengan pemeriksaan penunjang pemantauan pH- esofagus dan/MI impedance. Oleh karena itu, GER tidak menjadi pertimbangan pertama sebagai penyebab apneu atau ALTE’s pada bayi; banyak faktor lain mempengaruhi kejadian tersebut, terutama pada bayi prematur terkait dengan imaturitas sistem susunan saraf pusat.8
Kajian dengan menggunakan pH-esofagus dan MI impedance memperlihatkan hubungan sementara antara 30% kejadian apneu sentral episode pendek non patologis dengan GER.31 Temuan ini tidak dapat diasumsikan sebagai apneu patologis pada bayi dan merupakan upaya proteksi dari pernapasan selama regurgitasi. Kajian lain memperlihatkan hubungan yang lemah antara apneu dan episode refluks.32,33 Penelitian lain menemukan hubungan antara apneu yang berlangsung > 30 detik dengan refluks asam pada bayi prematur.34 Satu penelitian terdahulu, memperlihatkan apneu singkat berhubungan erat dengan regurgitasi dan tidak terlihat pada sebagian besar apneu yang berlangsung >20 detik.35 Pada kasus yang sudah sangat terseleksi, GER berhubungan dengan apneu sentral patologi.36 Tidak satupun publikasi memberikan kesimpulan adanya hubungan sebab dan akibat antara GER dan apneu patologi.
ALTEs adalah kumpulan gejala klinis apneu, perubahan warna kulit (sianosis, pucat, pletora), tonus otot abnormal, cegukkan, atau tersendak pada bayi yang memerlukan intervensi.37ALTEs berhubungan dengan infeksi, obstruksi saluran napas atas, gangguan kardiovaskular, respirasi, metabolik, dan neurologi. Hubungan ALTEs dengan GER mungkin bukan bersifat patologis, beberapa kejadian ALTE’s dihubungkan dengan refleks proteksi menahan napas saat bayi mengalami retching atau saat faring terisi cairan lambung.8
Simpulan
Beberapa gejala klinis yang diduga sebagai petanda GERD tidak didukung oleh bukti ilmiah kuat. Para dokter diharapkan dapat lebih memahami gejala klinis GER dan GERD agar bayi yang mengalami regurgitasi mendapat tata laksana yang rasional
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