To the Editor: There are many problems with the study by Orenstein et al. (Sept. 29 issue).1 I am unsure that all children had gastroesophageal reflux, since asymptomatic children (n = 28) have had esophageal pH below 1 approximately 20 per cent of the time, on the average, after apple-juice feedings.2 It is difficult to differentiate pathologic from physiologic reflux during these postcibal periods. Investigators who report otherwise3 have been misled by selecting “normal” controls at the low end of the normal spectrum. In addition, the state of alertness was not accounted for, as it was by Meyers and Herbst.
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