Pediatric Pulmonology 50:936–944 (2015) Review Influence of Respiratory Physiotherapy on Gastro- Oesophageal Reflux in Infants: A Systematic Review Filip Van Ginderdeuren, PT, MSc, 1,2 * Eric Kerckhofs, PT, PhD, 1 Michel Deneyer, MD, PhD, 3 Sylvie Vanlaethem, PT, MSc, 2 and Yvan Vandenplas, MD, PhD 3 Summary. Purpose: To provide a survey on the literature concerning the influence of respiratory physiotherapy on gastro-oesophageal reflux (GOR) in infants and young children. Methods: Electronic databases (Pubmed, Web of Science, PEDro) and reference lists of articles and narrative reviews were searched. Articles were included when infants and small children underwent oesophageal pH monitoring or pH-multichannel intraluminal impedance monitoring while respiratory physiotherapy was administered. Descriptive analysis was performed and two researchers scored the methodological quality of these studies. Results: Out of 985 articles, seven (six English, one French) have been included, In total 277 patients were involved, 71 with cystic fibrosis. Depending on the technique used, four studies showed GOR to be aggravated during therapy, three studies reported no effect. Conclusion: The evidence is not conclusive on whether respiratory physiotherapy induces or aggravates GOR in infants and small children. Age, disease, and treatment options play an important role. More specific research, also focussing on the influence of respiratory physiotherapy on non-acid reflux and the impact of recently developed airway clearance techniques (ACT’s) on GOR is necessary. Pediatr Pulmonol. 2015;50:936– 944. © 2015 Wiley Periodicals, Inc. Key words: airway clearance techniques; respiratory physiotherapy; gastro- oesophageal reflux; infants; cystic fibrosis. INTRODUCTION Gastro-oesophageal reflux (GOR) occurs in more than two-third of healthy infants. 1 GOR is defined as the passage of gastric contents into the oesophagus and has to be distinguished from gastro-oesophageal reflux disease (GORD), which includes troublesome symptoms or complications associated with GOR. 2 GOR is a normal physiologic process, generally associated with transient relaxations of the lower oesophageal sphincter independent of swallowing, which permits gastric contents to enter the oesophagus. Regurgitation or spitting up is reported to occur daily in 50% of all infants. Nelson et al. found that regurgitation of at least one episode a day was reported in half of 0–3 months old infants. This symptom decreased to 5% at 10– 12 months of age. Peak reported regurgitation was 67% at 4 months. 3 Age distribution shows that the normal range for the reflux index in 509 healthy infants during the first 12 months of life is about 10% (95 percentile), decreasing from 13% at birth to 8% at 12 months. 4 Coughing, laryngitis, and wheezing are extra-oesophageal symptoms and conditions associated with GORD in infancy. 5 1 Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium. 2 Physiotherapy Department, UZ Brussel, Brussels, Belgium. 3 UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium. Conflicts of interest: None. Ã Correspondence to: Filip Van Ginderdeuren, PT, MSc, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103 1090 Brussels, Belgium. E-mail: Filip.vanginderdeuren@uzbrussel.be Received 24 February 2015; Revised 27 April 2015; Accepted 13 May 2015. DOI 10.1002/ppul.23218 Published online 10 June 2015 in Wiley Online Library (wileyonlinelibrary.com). ß 2015 Wiley Periodicals, Inc.