Download Gastroesophageal Reflux

Gastroesophageal
Reflux in Infants and Children
Melissa Velez
What is Gastroesophageal Reflux
Disease?
 When highly acidic contents of the stomach
are refluxed back up to the esophagus


These gastric contents irritate and sometimes
damage mucosal surfaces of the esophagus
It is a clinical condition that is severe enough
to impact the patient’s life and/or damage the
esophagus
Gastroesophageal Reflux in
Infants
 An infant will throw up after almost every
feeding and many times between feedings.
 This is usually due to an incoordination or
immaturity of the upper respiratory tract.
 Parents often worry that something more is
wrong with the baby’s stomach


Ulcer
Not keeping enough food down to grow
Common Symptoms
 It is unknown whether adults and infants
have the same symptoms
 Infants are most likely to have:



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Frequent or recurrent vomiting
Heartburn
Gas
Abdominal pain
Symptoms Blamed on Reflux
that are Less Common in Infants
 Poor growth

Unintentional limiting child’s caloric intake
 Laryngeal Penetration



In children with neurological impairments
Aspirate refluxed stomach contents
Swallow-breathe patterns are not well
coordinated
Symptoms Blamed on Reflux
(Continued)
 Chronic congestion and hoarseness

Results in stridor or laryngospasms
 Chronic asthma


Difficulty knowing whether reflux causes asthma
or asthma causes reflux
Reported incidence of reflux ranging between
46-75%
What happens with
gastroesophageal reflux?
 In children with reflux there is some incoordination
of the upper intestinal tract
 The infant will eat too fast but will not choke or gag
during feedings which suggests that there is no
difficulty getting food from their mouth to their
esophagus
 Since the stomach contracts normally, most of the
time the infant will not be bothered by reflux
Differences Between Infants
and Adults (Vomiting)
 An infant with reflux or an adult with an
intestinal flu virus


An infant does not show discomfort before or
after vomiting
An adult will show symptoms of being sick
beforehand such as nausea, sweating,
salivating, and swallowing
Diagnosis
 Usually hearing the parents story and seeing
the child is enough to determine this problem
 A few diagnostic tests that are given when
further testing is recommended



Barium Swallow or Upper GI series
pH Probe
Endoscopy
Barium Swallow
 X-ray allowing doctors to follow food down
the infants esophagus into the intestines
 Doctor is able to see if there are twists, kinks,
or a narrowing of the upper intestinal tract
 Not very reliable
pH Probe
 Performed by the use of a small wire with an
acid sensor
 Starts at the infants nose and ends at the
bottom of the esophagus
 Sensor is left in place for 12-24 hours
 The severity of the reflux does not always
correlate with the severity of the symptoms
Endoscopy
 A flexible endoscope with lights and lenses
are passed through the infants mouth.
 Esophagitis

Due to repeated exposure of the esophagus to
stomach acid
 Less than half of the infants with severe
symptoms do not develop esophagitis
Treatment
 Positioning the baby

After feeding, put the baby on his stomach, and
elevate the head
 Changing feeding schedules

Feed baby smaller amounts more often
 Dietary treatments

Parents are instructed to thicken their infants
formula with cereal
Treatment Continued
 Medications are used:



Lessen intestinal gas
Decrease or neutralize
stomach acid
Improve intestinal
coordination
 Surgery


Extremely rare
Nissen Fundoplication
Research
 Recent experimental data suggests that
Sudden Infant Death Syndrome (SIDS) may
also be related to GERD.
 Another study included 72 children with
chronic cough and normal findings on chest
radiographs, GERD was implicated as the
casue of symptoms in 15 % of the patients.
References
 Ahuja, V., Lassen, L., & Yencha, M. (1999, September). Head and neck
manifestations of gastroesophageal reflux disease. American Family
Physician, 60, 873-86.
 Ashorn,M., Ruuska,T., & Karikoski,R. (2002, June). The natural course
of gastroesophageal reflux disease in children. Scandinavian Journal of
Gastroenterology, 37, 638-641.
 Center for Voice Disorders of Wake Forest University. Sheet on reflux.
Retrieved on March 29, 2003, from http://bgsm.edu/voice/pt_info.html
 Center for Voice Disorders of Wake Forest University. Reflux and voice
disorders. Retrieved on March 29, 2003, from
http://www.bgsm.edu/voice/reflux.html
 Children’s Medical Center of the University of Virginia.
Gastroesophageal Reflux in Infants. Retrieved on April 1, 2003, from
http://www.people.virginia.edu/~smb4v/tutorials/reflux/ger.html