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Gastroesophageal
Reflux Disease
(GERD)
In The Child
Elizabeth Boldon, RN, MSN
Elizabeth Boldon is a Nurse Education
Specialist at Mayo Clinic in Rochester,
Minnesota. She received a BSN from Allen College in Waterloo, Iowa in 2002 and an
MSN with a focus in education from the University of Phoenix in 2008. She has
bedside nursing experience in medical neurology and the neuroscience ICU.
Abstract
Gastroesophageal reflux disease (GERD) is defined as a condition that
develops when the reflux of stomach contents causes troublesome
symptoms with or without mucosal damage and/or complications. GERD
symptoms can include nausea, dysphagia, burning chest or abdominal pain,
respiratory disorders and mild to severe damage to the esophageal lining
and functioning. Patients that are not investigated for symptoms or not
followed up through recommended diagnostic testing when damage to the
esophagus has occurred are at risk of further injury and complications,
including Barrett’s esophagus (a precancerous condition). Although GERD is
more common in adults, up to 25 percent of children and teens have
symptoms of GERD. The diagnosis, symptoms, complications and standard
medical and surgical treatment of GERD in children are discussed.
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Continuing Nursing Education Course Planners
William A. Cook, PhD, Director, Douglas Lawrence, MA, Webmaster,
Susan DePasquale, MSN, FPMHNP-BC, Lead Nurse Planner
Policy Statement
This activity has been planned and implemented in accordance with the
policies of NurseCe4Less.com and the continuing nursing education
requirements of the American Nurses Credentialing Center's Commission on
Accreditation for registered nurses. It is the policy of NurseCe4Less.com to
ensure objectivity, transparency, and best practice in clinical education for
all continuing nursing education (CNE) activities.
Continuing Education Credit Designation
This educational activity is credited for 2 hours. Nurses may only claim credit
commensurate with the credit awarded for completion of this course activity.
Statement of Learning Need
Nurses need to recognize and stay informed of symptoms of
gastroesophageal reflux disease (GERD) in the child, including the current
and evolving trends in GERD diagnosis and treatment management.
Course Purpose
To provide nursing professionals with knowledge to care for children with
GERD and to help support improved quality of life.
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Target Audience
Advanced Practice Registered Nurses and Registered Nurses
(Interdisciplinary Health Team Members, including Vocational Nurses and
Medical Assistants may obtain a Certificate of Completion)
Course Author & Planning Team Conflict of Interest Disclosures
Elizabeth Boldon, RN, MSN, William S. Cook, PhD, Douglas Lawrence, MA,
Susan DePasquale, MSN, FPMHNP-BC – all have no disclosures
Acknowledgement of Commercial Support
There is no commercial support for this course.
Activity Review Information
Reviewed by Susan DePasquale, MSN, FPMHNP-BC
Release Date: 1/1/2016
Termination Date: 10/28/2018
Please take time to complete a self-assessment of knowledge, on
page 4, sample questions before reading the article.
Opportunity to complete a self-assessment of knowledge learned
will be provided at the end of the course.
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1.
Up to ______ percent of children and teens have symptoms of GERD,
although GERD is more common in adults.
a. 10
b. 12
c. 25
d. 40
2.
Regurgitation is present in ____ to ____ percent of all infants, peaks at
age four months, and typically resolves by one year.
a. 20 to 30
b. 50 to 70
c. 65 to 70
d. none of the above
3.
GERD is common in children with _____________, and may be
manifested only by unexplained or self-injurious behaviors.
a. asthma
b. LES deformity
c. autism
d. a strong family history
4.
H2RAs have ____________ effect on gastroesophageal reflux.
a. moderate
b. minor
c. high
d. indeterminate
5.
True/False. Endoscopy can be performed in infants, toddlers, and older
children.
a. True
b. False
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Introduction
Gastroesophageal reflux (GER) happens when stomach contents come back
up into the esophagus. Stomach acid that touches the lining of the
esophagus can cause heartburn, also called acid indigestion. Occasional GER
is common in children and teens — ages 2 to 19 — and doesn’t always mean
that they have gastroesophageal reflux disease (GERD). GERD is a more
serious and long-lasting form of GER in which acid reflux irritates the
esophagus. GER that occurs more than twice a week for a few weeks could
be GERD. GERD can lead to more serious health problems over time.
Up to 25 percent of children and teens have symptoms of GERD, although
GERD is more common in adults. This course will discuss GERD, its
symptoms, causes, methods of diagnosis, complications and treatments.
What Is GERD?
“Gastroesophageal reflux” (GER) refers to the passage of gastric contents
into the esophagus. This is a normal physiologic process that occurs in
healthy infants, children, and adults. Most episodes are brief and do not
cause symptoms, esophageal injury, or other complications. In contrast,
“gastroesophageal reflux disease” (GERD) is present when the reflux
episodes are associated with complications or troublesome symptoms.1
Regurgitation in infants is common and typically decreases or resolves
during the first year of life. Although the problem usually resolves by the end
of infancy, there is a weak association with GERD later in life. As an
example, frequent regurgitation during infancy and a history of GERD in the
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mother (but not the father) both
predict the risk of reflux-related
symptoms during childhood. Symptoms
of GERD during childhood are
moderately likely to persist to
adolescence and adulthood.1
Several questions related to the
epidemiology and natural history of
GERD in children remains unanswered.
There is only a partial understanding of
the relationship between GER and
respiratory diseases, including asthma,
chronic cough, and recurrent
pneumonia. In addition, the
relationship between childhood GERD and related complications in adulthood
is unclear. Finally, the healthcare burden related to the diagnosis and
treatment of childhood GERD and the impact of GERD on quality of life for
children and their families have not been fully examined.1
Symptoms of GERD in Children
The most common symptoms of gastroesophageal reflux (GER) and
gastroesophageal reflux disease (GERD) vary according to age, although
overlap may exist.
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Infants
Gastroesophageal reflux is common in
infants and usually is not pathological.
Regurgitation is present in 50 to 70
percent of all infants, peaks at age four
months, and typically resolves by one
year. A small minority of infants with
GER develops other symptoms
suggestive of GERD, including feeding
refusal, irritability, hematemesis,
anemia, respiratory symptoms, and
failure to thrive.1
Preschool
Preschool age children with GERD may present with intermittent
regurgitation. Less commonly, they may have respiratory complications
including persistent wheezing. Decreased food intake or poor weight gain
without any other complaints may be a symptom of esophagitis in young
children.
All of these symptoms are nonspecific and insufficient to make a definitive
diagnosis of GERD. A more specific symptom of GERD is Sandifer syndrome,
an unusual posturing consisting of arching of the back, torsion of the neck,
and lifting up of the chin. Sandifer syndrome is most often found in
preschool-aged children who are developmentally delayed, but also may be
seen in children without neurologic abnormalities.1
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Older Children and Adolescents
The pattern of symptoms and complications of GERD in older children and
adolescents resemble that seen in adults. The cardinal symptoms are chronic
heartburn and/or regurgitation. Complications of GERD, including
esophagitis, strictures, Barrett's esophagus, and hoarseness due to reflux
laryngitis also may be seen. Older children may complain of nausea,
dysphagia (difficulty swallowing) and/or epigastric pain, but many preadolescents will not localize pain and report diffuse abdominal discomfort.1
Gastroesphageal disorder-related chest pain is not well described by young
children. Young or nonverbal children may be observed pounding their chest.
GERD is common in children with autism, and may be manifested only by
unexplained or self-injurious behaviors. In older children, chest pain typically
is described as squeezing or burning, located substernally and sometimes
radiating to the back, lasting anywhere from minutes to hours, and resolving
either spontaneously or with antacids. It usually occurs after meals, awakens
patients from sleep, and may be exacerbated by emotional stress.1
Etiology Of GERD In Children
Like in adults with the condition, gastroesophageal reflux is the upward
movement of stomach contents into the esophagus and sometimes into or
out of the mouth. Usually infants with the condition are otherwise healthy,
but some infants have other problems affecting their nerves, brain, or
muscles. Generally, a child's immature digestive system is usually to blame.
Most infants grow out of GERD by the time they are one-year old.
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In older children, the causes of
GERD are different than what is
seen in infants and adults.
Anything that causes the muscular
valve between the stomach and
esophagus (the lower esophageal
sphincter or LES) to relax, or
anything that increases the
pressure below the LES, can cause
GERD. Such things include obesity,
overeating, constipation, and
certain foods, beverages, and
medications.2
Diagnosis Of GERD In Children
This section briefly covers diagnostic tools to identify GERD in children,
including screening tools, empiric treatment, and more invasive techniques
to identify causes underlying GERD symptoms of abdominal pain and
associated complications.
A number of diagnostic options to
determine management are available to
clinicians evaluating children with
symptoms of GERD. Helicobacter pylori
or H. pylori test-and-treatment as an
initial diagnostic and treatment strategy
is a common approach. If H. pylori
were to be detected, empiric antibiotic therapy can be prescribed to
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hopefully eradicate the infection. One technique is to prescribe empiric
antisecretory (reduction of gastric acid level generally through PPI
medication) therapy first and test for H. pylori later if treatment fails to
eradicate symptoms. A final approach to diagnose GERD is to perform upper
endoscopy or esophagogastroduodenoscopy (EGD) for patients with
dyspepsia.
The best diagnostic option for children remains a topic of debate. The Rome
Foundation, discussed later, researches and reviews patient care outcome
data to help guide clinician’s to make a rational decision.
Screening Questionnaires
Screening questionnaires can offer a useful diagnostic aid tool. Working
committees of the Rome Foundation (an international symposium of
gastrointestinal disease and psychiatry experts) has developed screening
questionnaire tools for pediatric gastrointestinal symptoms. Original
questionnaires were used to screen for pediatric functional gastrointestinal
disorders and symptoms. Newer screening tools have been developed with
input from recent Child and Adolescent Committees of the Rome Foundation
with updated criteria and scoring methods to diagnose GERD in the pediatric
population.
Screening questionnaires include a patient and parent-report for children
four years of age and older. A child self-report has been identified as more
appropriate to children ten years of age and older, and has been
recommended as preferred to a parent report. The questionnaire uses scales
to measure frequency, severity, and duration of GERD symptoms and may
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be scored to assess whether a patient meets the criteria to diagnose
pediatric GERD as well as other gastrointestinal functional disorders. A
diagnostic coding system is included that allows the health provider to
assign a provisional diagnosis to symptoms identified in the screening
questionnaire. Screening questionnaires are considered a supportive method
to diagnose pediatric GERD, and not intended to replace medical evaluation
and clinical judgment important to an accurate diagnosis.3
Empiric Treatment
An empiric trial of acid suppression is often used as a diagnostic test, and is
suggested for older children and adolescents with uncomplicated heartburn.
The trial typically consists of a two- to four-week course of acid-suppressing
medication (i.e., a proton pump inhibitor). Empiric treatment is not a
valuable diagnostic test in infants and young children, in whom symptoms of
GERD are less specific. Studies in adults suggest that empiric treatment may
be a cost-effective approach in selected patients, although the applicability
of these results to children is uncertain.4
Barium Contrast Radiography
Barium studies of the esophagus are neither sensitive nor specific for the
diagnosis of GERD. Thus, radiologic evaluation is not useful to confirm or
exclude GERD in children. However, it can be useful in the evaluation of
selected patients with atypical or severe presenting features, particularly
those with dysphagia or odynophagia. In such patients, the barium contrast
study is used to evaluate for the possibility of anatomic abnormalities,
including hiatal hernia, achalasia, tracheoesophageal fistula, anastomotic
strictures, antral web, intestinal malrotation, or peptic strictures.4
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Endoscopy and Histology
Endoscopic evaluation of the upper gastrointestinal tract is indicated for
selected patients in whom esophagitis or gastritis is suspected. These
include children or adolescents with heartburn, hematemesis, or epigastric
abdominal pain that fails to respond to or relapses quickly after empiric
treatment. In addition, endoscopy may be valuable in the evaluation of
patients with recurrent regurgitation, dysphagia, odynophagia, or a history
of food impaction, or in children with frequent reflux that continued from
infancy until after two years of age.
During endoscopy, the examiner inspects the visual appearance of the
esophageal mucosa and anatomy, and usually takes a series of biopsies for
histologic examination. The findings help to determine the presence and
severity of esophagitis and complications, such as strictures or Barrett’s
esophagus, and to exclude other disorders such as eosinophilic esophagitis,
allergic esophagitis, or infectious esophagitis.
Endoscopy can be performed in infants, toddlers, and older children.
Procedure-related complications of diagnostic endoscopy and biopsy are
rare. Complications may occur due to over- or under-sedation.4
Esophageal pH Monitoring or Impedance Monitoring
Esophageal pH monitoring permits the assessment of the frequency and
duration of esophageal acid exposure and its relationship to symptoms.
However, the results do not correlate consistently with symptom severity or
objective findings on endoscopy. Therefore, pH monitoring can raise or lower
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suspicion of GERD, but is not a definitive diagnostic test, and is not useful in
many clinical situations, especially in infants.
The test involves passing a catheter through the nose into the lower
esophagus, where pH is continuously measured by a microelectrode. The pH
electrode is positioned according to a formula that takes into account the
length of the child. Radiologic or manometric confirmation of the position of
the tip of the probe usually is not necessary. A device is worn by the patient
and records esophageal acid exposure during the period of monitoring. The
procedure is considered to be very safe, but keeping the probe in place may
be difficult in toddlers and uncooperative children.
Newer pH study devices that clip a capsule to the esophageal mucosa and
remain in place for 24 – 48 hours allow recording of intraesophageal pH
without the transnasal catheter. This technology can be used for older
children and is particularly beneficial for children with autism in whom
transnasal pH monitoring studies may be difficult to perform.
The type of recording device, 24-hour pH probe or 24-48 hour capsule
placement in the esophagus, the patient’s diet, body position (erect or
supine), and the activity of the patient during the study will influence the
result or final report of a pH study. Interpretation of the test results after
longer periods of monitoring (24 - 48 hours) generally is more reliable than
after shorter periods (i.e., < 24 hours), although longer periods of
monitoring may not always be feasible.4
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Multichannel intraluminal impedance monitoring (MII) is a newer technique
that permits measurement of all reflux episodes, including those that are
acid, weakly acidic and alkaline. MII is now available at many centers, and
usually is used in combination with pH monitoring so that episodes of acid
reflux may be distinguished from non-acid reflux. Although pediatric
standards for MII have not been established, the technique can be helpful to
determine whether there is a correlation between reflux episodes and certain
symptoms.4
Complications Of GERD In Children
Without treatment, GERD can sometimes cause serious complications over
time. Complications of GERD are identified briefly below.5
Esophagitis and Esophageal Stricture
Esophagitis involves mucosal injury of the esophagus and may lead to
ulcerations, a sore in the lining of the esophagus.
An esophageal stricture happens when a person’s esophagus becomes too
narrow. Esophageal strictures can lead to problems with swallowing.
Respiratory Problems
A child or teen with GERD might breathe stomach acid into his or her lungs.
The stomach acid can then irritate the throat and lungs, causing respiratory
problems or symptoms, such as:
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
asthma

chest congestion, or extra fluid in the lungs

a dry, long-lasting cough or a sore throat

hoarseness

laryngitis

pneumonia

wheezing
Treatment Of GERD In Children
Medical providers often suggest lifestyle changes as an initial approach to
treatment for children and adolescents with mild or infrequent symptoms of
gastroesophageal reflux, such as occasional heartburn or painless
regurgitation. Lifestyle changes also may be helpful as an adjunct to
pharmacologic treatment in patients with moderate or severe symptoms
suggestive of gastroesophageal reflux disease.3 The type of lifestyle changes
that may be beneficial depend upon the patient's age and symptom
characteristics, as described below.
Infants:

Elevating the head of the baby's crib or bassinet

Holding the baby upright for 30 minutes after a feeding

Thickening bottle feedings with cereal (should not be done without a
medical provider's supervision)

Changing feeding schedules

Trying solid food (with a provider's approval)
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Older children:

Elevating the head of the child's bed

Keeping the child upright for at least two hours after eating

Serving several small meals throughout the day, rather than three
large meals

Limiting foods and beverages that seem to worsen the child's reflux

Encouraging the child to get regular exercise
Medications that are used for treatment of gastroesophageal reflux disease
can be grouped into the following categories:

Proton pump inhibitors (PPI)

Histamine type 2 receptor antagonists (H2RA)

Antacids

Prokinetics

Surface agents
Proton Pump Inhibitors
Proton pump inhibitors (PPIs) block acid secretion by irreversibly binding to
and inhibiting the hydrogen-potassium ATPase pump that resides on the
luminal surface of the parietal cell membrane. The drugs in this class include
omeprazole, lansoprazole, rabeprazole, pantoprazole, and esomeprazole.
The differences in pharmacology and efficacy among drugs in this class
appear to be small and of uncertain clinical significance, thus it is reasonable
to make treatment decisions based on cost and on which dosing formulation
is accepted by the child.
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Omeprazole, esomeprazole, and lansoprazole have been most extensively
studied in children and are approved by the U.S. Food and Drug
Administration (FDA) for this age group, but not in infants.4
Histamine Type 2 Receptor Antagonists
For patients with mild or intermittent symptoms of GERD, providers often
suggest a trial of histamine type 2 receptor antagonists (H2RAs) rather than
PPIs or other drugs. H2RAs have moderate effects on gastroesophageal
reflux, as measured by relief of symptoms and mucosal healing, but because
these medications have a relatively rapid onset of action they are well suited
for providing symptomatic relief. However, they are somewhat less effective
than the PPI class, especially for chronic use.
The H2RAs inhibit acid secretion by blocking histamine H2 receptors on the
parietal cell. Four H2RAs are available in the United States, in both
prescription strength and a lower strength for non-prescription (over-thecounter) sales:4

Cimetidine (Tagamet)

Ranitidine (Zantac)

Famotidine (Pepcid)

Nizatidine (Axid)
Antacids
Antacids are appropriate for shortterm relief of heartburn in older
children, adolescents, or adults with
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infrequent symptoms (less than once a week). Antacids begin to provide
relief of heartburn within five minutes but have a short duration of effect of
30 to 60 minutes. The efficacy and safety of antacids have not been well
studied, and chronic use is generally not recommended, especially in infants.
Antacids work by neutralizing gastric pH and thereby decreasing the
exposure of the esophageal mucosa to gastric acidity during episodes of
reflux. Various preparations that are commercially available usually contain
the combination of magnesium and aluminum hydroxide or calcium
carbonate.4
Prokinetics
Prokinetic drugs have a very limited role in management of GERD because of
significant safety concerns and limited efficacy. Systematic reviews have not
supported the use of metoclopramide, cisapride, or domperidone for
treatment of GERD. These drugs should be considered for use only in
carefully selected patients who have problems with gastric emptying because
of gastric dysmotility (gastroparesis), contributing to GERD. Erythromycin
also is used for patients with gastric dysmotility, such as post-viral
gastroparesis, but its use is limited by side effects and tachyphylaxis
(tolerance).
Baclofen is a gamma-amino-butyric acid B (GABA-B) receptor agonist that
inhibits the transient relaxations of the lower esophageal sphincter that are a
predominant mechanism of reflux. A limited body of evidence in adults and
children suggests that baclofen reduces reflux symptoms after acute or
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chronic dosing, reduces the frequency of esophageal sphincter relaxation
and esophageal acid exposure, and accelerates gastric emptying.
Potential side effects include dyspepsia, drowsiness, and lowered seizure
threshold. Because of side effects, baclofen is rarely used to treat GERD in
children without underlying neurological problems. However, it is
occasionally used for children with cerebral palsy, in whom it may also
improve spasticity.4
Surface Agents
Surface agents work by creating a barrier that impedes peptic injury to
mucosal surfaces. Only two such substances have been evaluated in the
treatment of GERD: sodium alginate and sucralfate.
Sucralfate (aluminum sucrose sulfate) adheres to the mucosal surface,
promoting healing and protecting from further peptic injury by mechanisms
that are incompletely understood. Because of short duration of action,
concerns related to aluminum toxicity and limited efficacy as compared with
PPIs, sucralfate has a minimal, if any, role in the treatment of GERD in
children (or adults).
Sodium alginate, which is derived from seaweed, forms a surface gel that
creates a physical barrier against regurgitation of gastric contents and
protects the esophageal mucosa. Studies comparing its efficacy on
symptoms and esophageal acid exposure with other available treatments
have produced conflicting results. It currently is used infrequently in the
treatment of children with GERD.4
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Surgery
Antireflux surgery appears to be successful in controlling reflux in many
patients with debilitating gastroesophageal reflux disease (GERD) that is
refractory to medical management,2 but the indications for and outcome of
the intervention have not been systematically studied. Many of the children
who have undergone antireflux surgery have underlying neurological
impairment such as cerebral palsy.
Surgery is most often considered for patients with intractable esophagitis or
emesis that does not respond to proton pump inhibitors (PPIs), or pulmonary
disease that is clearly due to aspiration from refluxed material. It may be
challenging to discriminate pulmonary disease from aspiration associated
with swallowing from that related to reflux.
The Nissen fundoplication is the most often performed surgery. During this
procedure, the top part of the stomach is wrapped around the esophagus
forming a cuff that contracts and closes off the esophagus whenever the
stomach contracts - preventing reflux. The procedure is usually effective, but
it is not without risk. Potential risks and benefits of this operation should be
discussed with health care providers before it is performed.
Endoscopic Techniques
Endoscopic techniques, such as endoscopic sewing and radiofrequency, help
control GERD in a small number of people. Endoscopic sewing uses small
stitches to tighten the sphincter muscle. Radiofrequency creates heat
lesions, or sores, that help tighten the sphincter muscle. A surgeon performs
both operations using an endoscope at a hospital or an outpatient center,
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and the child or teen receives general anesthesia. The results for endoscopic
techniques may not be as good as those for fundoplication.5
Summary
Gastroesophageal reflux disease occurs in children when acid from the
stomach backs up into the esophagus. This can cause a range of symptoms
as well as discomfort for the child. Through proper diagnosis, there can be
effective treatments. Screening tools are useful to support diagnostic
decisions, however evaluation and follow up of patients are generally
recommended for providers treating individuals with GERD in a primary care
setting. A number of treatment management options are available for
clinicians managing GERD symptoms in children. Often, patient and parent
reassurance and education is generally pursued, with possible use of overthe-counter antacids, H2-blockers or PPIs. Other strategies may be used to
evaluate treatment response and determine further evaluation if symptoms
do not abate. New data in patient trends and research are continually
evolving to support clinicians making diagnostic and treatment choices.
Please take time to help NurseCe4Less.com course planners evaluate
the nursing knowledge needs met by completing the self-assessment
of Knowledge Questions after reading the article, and providing
feedback in the online course evaluation.
Completing the study questions is optional and is NOT a course
requirement.
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1.
Up to ______ percent of children and teens have symptoms of GERD,
although GERD is more common in adults.
a. 10
b. 12
c. 25
d. 40
2.
Regurgitation is present in ____ to ____ percent of all infants, peaks at
age four months, and typically resolves by one year.
a. 20 to 30
b. 50 to 70
c. 65 to 70
d. none of the above
3.
GERD is common in children with _____________, and may be
manifested only by unexplained or self-injurious behaviors.
a. asthma
b. LES deformity
c. autism
d. a strong family history
4.
H2RAs have ____________ effect on gastroesophageal reflux.
a. moderate
b. minor
c. high
d. indeterminate
5.
True/False. Endoscopy can be performed in infants, toddlers, and older
children.
a. True
b. False
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6.
GERD symptoms in children:
a. are no different than adults
b. vary according to age
c. may include overlap
d. answers b and c above
7.
Omeprazole is an example of a(n):
a. Antacid (over the counter)
b. H2 blocker
c. Proton pump inhibitor
d. Either a or b above
8.
Antacids begin to provide relief of heartburn within 5 minutes but have
a duration of effect of ___________.
a. more than 2 hours
b. 30 – 60 minutes
c. 8 hours
d. that is unknown
9.
True/False. Sandifer syndrome is most often found in preschool-aged
children who are high achievers and with compulsive traits.
a. True
b. False
10. Sodium alginate
a. is derived from seaweed
b. forms a surface gel that creates a physical barrier
c. protects against regurgitation of gastric contents and the esophageal
mucosa
d. All of the above
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11. Many of the children who have undergone antireflux surgery have
a. significant food allergies
b. underlying neurological impairment, such as cerebral palsy
c. celiac sprue
d. Answers a and c above
12. Sucralfate (aluminum sucrose sulfate)
a. adheres to the mucosal surface
b. promotes healing and protects from further peptic injury
c. protects mucosal tissue by mechanisms that are well
documented and understood
d. Answers a and b above
13. True/False. Endoscopic sewing uses small stitches to close an ulcer.
a. True
b. False
14. True/False. Surgery is most often considered for patients with
intractable esophagitis or emesis that does not respond to proton pump
inhibitors (PPIs), or pulmonary disease that is clearly due to aspiration
from refluxed material.
a. True
b. False
15. Baclofen
a. a gamma-amino-butyric acid A (GABA-A) receptor agonist
b. inhibits transient relaxations of the lower esophageal sphincter
c. reduces reflux symptoms for only chronic conditions
d. slows gastric emptying
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Correct Answers:
1.
Up to ______ percent of children and teens have symptoms of GERD,
although GERD is more common in adults.
Correct Answer: 25
2.
Regurgitation is present in ____ to ____ percent of all infants, peaks at
age four months, and typically resolves by one year.
Correct Answer: 50 to 70
3.
GERD is common in children with _____________, and may be
manifested only by unexplained or self-injurious behaviors.
Correct Answer: autism
4.
H2RAs have ____________ effect on gastroesophageal reflux.
Correct Answer: moderate
5.
True/False. Endoscopy can be performed in infants, toddlers, and older
children.
Correct Answer: True
6.
GERD symptoms in children:
Correct Answer: answers b and c above
7.
Omeprazole is an example of a(n):
Correct Answer: Proton pump inhibitor
8.
Antacids begin to provide relief of heartburn within 5 minutes but have
a duration of effect of ___________.
Correct Answer: 30 – 60 minutes
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9.
True/False. Sandifer syndrome is most often found in preschool-aged
children who are high achievers and with compulsive traits.
Correct Answer: True
10. Sodium alginate
Correct Answer: All of the above
11. Many of the children who have undergone antireflux surgery have
Correct Answer: underlying neurological impairment, such as cerebral
palsy
12. Sucralfate (aluminum sucrose sulfate)
Correct Answer: Answers a and b above
13. True/False. Endoscopic sewing uses small stitches to close an ulcer.
Correct Answer: False
14. True/False. Surgery is most often considered for patients with
intractable esophagitis or emesis that does not respond to proton pump
inhibitors (PPIs), or pulmonary disease that is clearly due to aspiration
from refluxed material.
Correct Answer: True
15. Baclofen
Correct Answer: inhibits transient relaxations of the lower esophageal
sphincter
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References Section
The reference section of in-text citations include published works intended as
helpful material for further reading. Unpublished works and personal
communications are not included in this section, although may appear within
the study text.
1.
Winter, H.S. (2015). Clinical manifestations and diagnosis of
gastroesophageal reflux disease in children and adolescents in Hoppin,
A.G. (Ed.), UpToDate. Waltham, Mass: UpToDate. Retrieved October 19,
2015 from www.uptodate.com
2.
Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint
Recommendations of the North American Society for Pediatric
Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the
European Society for Pediatric Gastroenterology, Hepatology, and
Nutrition (ESPGHAN) (2009). Journal of Pediatric Gastroenterology and
Nutrition; 49:498-547 (2009). Retrieved online on October 27, 2015 @
http://www.naspghan.org/files/documents/pdfs/positionpapers/FINAL%20-%20JPGN%20GERD%20guideline.pdf.
3.
Rome III Diagnostic Questionnaire for the Pediatric Functional GI
Disorders: Appendix E. (2007). Rome Foundation. Retrieved online
October 25, 2015 from http://www.romecriteria.org/pdfs/pediatricq.pdf.
4.
Winter, H.S. (2015). Management of gastroesophageal reflux disease in
children and adolescents in Hoppin, A.G. (Ed.), UpToDate. Waltham,
Mass: UpToDate. Retrieved October 11, 2015 from www.uptodate.com
5.
Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease
(GERD) in Children and Teens. (2015). National Institute of Diabetes
and Digestive and Kidney Diseases. Retrieved October 20, 2015 from
www.niddk.nih.gov
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