Pediatric Gastroesophageal Reflux Disease (GER/GERD)
Therefore, LPR is only successfully diagnosed if parents are suspicious and the child undergoes a full evaluation by a specialist such as an otolaryngologist. Airway or breathing-related problems are the most commonly seen symptoms of LPR in infants and children and can be serious. If your infant or child experiences any of the following symptoms, timely evaluation is critical. During the first year, infants frequently spit up. This is essentially LPR because the stomach contents are refluxing into the back of the throat.
Medications that can be prescribed include antacids, ulcer medications, proton pump inhibitors, and foam barrier medications. To be effective, these medications are usually prescribed for at least one month, and may be tapered off later after symptoms are controlled. For some patients, it can take two to three months of taking medication(s) to see effects. GERD and LPR are usually suspected based on symptoms, and can be further evaluated with tests such as an endoscopic examination (a tube with a camera inserted through the nose), biopsy, special X-ray exams, a 24-hour test that checks the flow and acidity of liquid from your stomach into your esophagus, esophageal motility testing (manometry) that measures muscle contractions in your esophagus when you swallow, and emptying of the stomach studies. Some of these tests can be performed in an office.
However, in most infants, it is a normal occurrence caused by the immaturity of both the upper and lower esophageal sphincters, the shorter distance from the stomach to the throat, and the greater amount of time infants spend in the horizontal position. Only infants who have associated airway (breathing) or feeding problems require evaluation by a specialist. This is most critical when breathing-related symptoms are present.
The next endoscopic procedure that has been described in children is the Stretta procedure. In this procedure, radiofrequency energy is delivered in multiple levels around the GE junction (approximately 2-3â€‰cm). The intent is to create a high pressure zone that reduces reflux through scarring of the lower esophagus. This scarring not only creates a high pressure zone but it also causes a decrease in the number of transient LES relaxations due to disruption of adjacent vagal afferent fibers .
Others lose their appetite because all that stomach acid pushing up into the esophagus can hurt the throat and, in severe cases, make it hard to swallow. If your child has other symptoms along with spitting up or vomiting – such as irritability during and after eating, breathing problems, coughing, gagging, or growth problems – she may have gastroesophageal reflux disease, or GERD. pH monitoring. To measure the acidity inside of the esophagus.
Slower than normal emptying of stomach contents may predispose infants or children to GERD. Infants with gastroesophogeal reflux reflect the immaturity their nervous system.
- During the test, your child is asked to swallow a long, thin tube with a probe at the tip that will stay in the esophagus for 24 hours.
- LPR has the name “silent reflux” due to not necessarily triggering the usual symptoms of acid reflux, such as heartburn.
- In one approach the GE junction can be tightened by the endoscopic creation of plications and in another radiofrequency energy is delivered to the lower esophagus and cardia to obtain collagen remodeling and augment LES pressure.
- The fundus of the stomach can be wrapped around the distal esophagus either 360 degrees (i.e., Nissen fundoplication) or to lesser degrees (i.e., Thal or Toupet fundoplication).
- However, GERD can also occur in older children.
If you have specific questions about how this relates to your child, please ask your doctor. Medications may also be suggested – some form a barrier on top of the stomach contents to reduce the risk of them flowing backwards, while others damp down acid production in the stomach. Another type of medication speeds up the rate at which feed passes from the stomach into the duodenum and intestines.
The fundus of the stomach can be wrapped around the distal esophagus either 360 degrees (i.e., Nissen fundoplication) or to lesser degrees (i.e., Thal or Toupet fundoplication). Initially described in 1954 by Rudolph Nissen, the Nissen fundoplication has evolved to become the standard operation for the surgical treatment of GERD in children and adults . Nissen described the procedure as a 360 degree gastric fundoplication around the distal esophagus for a distance of 4-5 centimeters.
Surgery. In severe cases of reflux, surgery called fundoplication may be done.
Because GERD often gets blamed for a variety of symptoms, itâ€™s important to see a clinician who is not only able to help to make an accurate diagnosis of GERD but who also considers other possible diagnoses to avoid unnecessary treatment. Burp your baby several times during bottle-feeding or breastfeeding. Your child may reflux more often when burping with a full stomach. Do not allow your child to lie down or go to bed right after a meal. Serve the evening meal early–at least two hours before bedtime.
In some cases, medications may be indicated. GER and GERD in infants and children are diagnosed with a thorough history and physical exam by the childâ€™s pediatrician. Infants with GER are thriving children and do not have recurrent agitation or forceful ejection of breast milk/formula. They maintain good weight gain. No blood or X-ray tests are indicated.
Unlike GERD, LPR rarely produces heartburn, and is sometimes called silent reflux. GERD is caused by a failure of the lower esophageal sphincter. In healthy patients, the “angle of His”-the angle at which the esophagus enters the stomach-creates a valve that prevents duodenal bile, enzymes, and stomach acid from traveling back into the esophagus where they can cause burning and inflammation of sensitive esophageal tissue. Bile and stomach acid can reflux into the esophagus when another muscular valve, the lower esophageal sphincter, malfunctions. The lower esophageal sphincter separates the esophagus and stomach.