Gastroesophageal Reflux in Infants and Children

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GastroesophagealReflux in Infants and Children

• Melissa Velez

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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 patients life and/or damage the
  esophagus

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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 babys stomach
• Ulcer
• Not keeping enough food down to grow

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Common Symptoms

• It is unknown whether adults and infants have the
  same symptoms
• Infants are most likely to have
• Frequent or recurrent vomiting
• Heartburn
• Gas
• Abdominal pain

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Symptoms Blamed on Reflux that are Less Common in
Infants

• Poor growth
• Unintentional limiting childs caloric intake
• Laryngeal Penetration
• In children with neurological impairments
• Aspirate refluxed stomach contents
• Swallow-breathe patterns are not well coordinated

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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

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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

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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

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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

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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

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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

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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

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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

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Treatment Continued

• Medications are used
• Lessen intestinal gas
• Decrease or neutralize stomach acid
• Improve intestinal coordination
• Surgery
• Extremely rare
• Nissen Fundoplication

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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.

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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
• Childrens Medical Center of the University of
  Virginia. Gastroesophageal Reflux in Infants.
  Retrieved on April 1, 2003, from
  http//www.people.virginia.edu/smb4v/tutorials/re
  flux/ger.html