Evaluation and Management of the Pediatric Patients with Suspected Gastroesophageal Reflux Diseases (original) (raw)
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Clinical management of infants and children with gastroesophageal reflux disease
The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 2004
Gastroesophageal reflux refers to the passage of gastric contents including food, acid, and digestive enzymes up into the esophagus. Reflux is most commonly recognized in infants when it is associated with regurgitation, known as "spitting up," and it is usually a self-limited, benign process that has little or no effect on normal weight gain or development. Adults and adolescents may also have reflux, which is usually either asymptomatic or recognized as dyspepsia or "heartburn." Gastroesophageal reflux disease (GERD) is defined as symptoms or complications that result from reflux. Most evidence suggests the mechanism of reflux is due to transient relaxations of the lower esophageal sphincter at inappropriate times. The diagnosis of suspected GERD in infants and children depends on the age and the presenting symptoms. A thorough history, physical examination, and growth charts are sufficient for the evaluation and diagnosis of GERD in most infants with recurrent...
Gastroesophageal reflux in infants and children
Acta Chirurgica Iugoslavica, 2008
Gastroesophageal reflux disease (GERD) is the most common esophageal disorder and the most frequent reason why infants are referred to the pediatric gastroenterologist, affecting as much as 30% of the pediatric population. Presenting features of GERD in infants and children are quite variable and follow patterns of gastrointestinal and extra-esophageal manifestations that vary between individual patients and may change according to age. Patients may be minimally symptomatic, or may exhibit severe esophagitis, bleeding, nutritional failure, or severe respiratory problems. GERD is also complex for the diagnostic techniques required to assess its repercussions or explain its origin. Although different abnormalities in motility variables, such as lower eso-phageal sphincter (LES) function, esophageal peristalsis and gastric motor activity can contribute to the development of GERD, the degree of esophageal acid exposure represents the key factor in its pathogenesis. Esophageal pH monitoring, based on both the detection of acid reflux episodes and the measurement of their frequency and duration, has been regarded as the most sensitive and specific diagnostic tool for diagnosing reflux disease. The aim of this paper is to give a concise review for the clinicians encountering this specific disease in infants and children.
The Gastroesophageal Reflux in Infants and Children
Springer eBooks, 2004
Gastroesophageal reflux disease (GERD) is the most common esophageal disorder and the most frequent reason why infants are referred to the pediatric gastroenterologist, affecting as much as 30% of the pediatric population. Presenting features of GERD in infants and children are quite variable and follow patterns of gastrointestinal and extra-esophageal manifestations that vary between individual patients and may change according to age. Patients may be minimally symptomatic, or may exhibit severe esophagitis, bleeding, nutritional failure, or severe respiratory problems. GERD is also complex for the diagnostic techniques required to assess its repercussions or explain its origin. Although different abnormalities in motility variables, such as lower eso-phageal sphincter (LES) function, esophageal peristalsis and gastric motor activity can contribute to the development of GERD, the degree of esophageal acid exposure represents the key factor in its pathogenesis. Esophageal pH monitoring, based on both the detection of acid reflux episodes and the measurement of their frequency and duration, has been regarded as the most sensitive and specific diagnostic tool for diagnosing reflux disease. The aim of this paper is to give a concise review for the clinicians encountering this specific disease in infants and children.
Pediatric Gastroenterology, Hepatology & Nutrition, 2019
The diagnosis and management of gastro-esophageal reflux (GER) and GER disease (GERD) in infants and children remains a challenge. Published guidelines and position papers, along with Embase, MEDLINE, and the Cochrane Database were reviewed and summarized with the intent to propose a practical approach and management of GER and GERD for healthcare providers and to standardize and improve the quality of care for infants and children. For this purpose, 2 algorithms were developed, 1 for infants <12 months of age and the other for older children. None of the signs and symptoms of GER and GERD are specific and there is no gold standard diagnostic test or tool. Nutritional management is recommended as a first-line approach in infants, while in children, a therapeutic trial with antacid medication is advised for early management. The practical recommendations from this review are intended to optimize the management of GER in infants and older children and reduce the number of investigations and inappropriate use of medication.
Gastroesophageal reflux refers to the passage of gastric contents including food, acid, and digestive enzymes up into the esophagus. Reflux is most commonly recognized in infants when it is associated with regurgitation, known as "spitting up," and it is usually a self-limited, benign process that has little or no effect on normal weight gain or development. Adults and adolescents may also have reflux, which is usually either asymptomatic or recognized as dyspepsia or "heartburn." Gastroesophageal reflux disease (GERD) is defined as symptoms or complications that result from reflux. Most evidence suggests the mechanism of reflux is due to transient relaxations of the lower esophageal sphincter at inappropriate times. The diagnosis of suspected GERD in infants and children depends on the age and the presenting symptoms. A thorough history, physical examination, and growth charts are sufficient for the evaluation and diagnosis of GERD in most infants with recurrent vomiting or children with regurgitation and heartburn. Additional evaluation may include an upper gastrointestinal series, esophageal pH monitoring, or endoscopy. The goals of GERD management are eliminating symptoms, healing esophagitis, preventing complications, promoting normal weight gain and growth, and maintaining remission. Therapeutic options include lifestyle changes, pharmacologic therapy, and antireflux surgery. Currently available pharmacologic agents for the treatment of GERD include antacids, mucosal protectants, prokinetic agents, and acid suppressants. months old and 20%-40% of children less than six months of age. Gastroesophageal reflux appears to be highly age specific as most infants "outgrow" the problem between three and six months of age. 2 In fact, most all gastroesophageal reflux in infants resolves by 12 months of age. 3 The spontaneous resolution of gastroesophageal reflux most likely results from the ability to remain upright after meals, improving muscle tone of the Whitworth J, et al.
Gastroesophageal reflux and unexplained chronic respiratory disease in infants and children
Pediatric Pulmonology, 1987
Thirty-eight children, aged from a few weeks to 7 years, with severe chronic pulmonary disease and without gastrointestinal symptoms, were investigated for gastroesophageal reflux (GER), using prolonged pH probe monitoring and gastroesophageal scintiscanning. All treatments were discontinued before testing. GER was found in 24 patients (63%) (group I) and it was not obsewed in 14 patients (group 11). All patients of group I received antireflux treatment, consisting of cisapride; in 22 of 24 patients, GER was controlled, as indicated by improvement of either pH monitoring or scintiscanning. or both. Eighteen of these 22 (8P/o) had femission of their pulmonary disease, and only two patients of group I 1 (14%) had spontaneous remission of the respiratory symptoms. We concluded that GER was probably the cause of the respiratory disease in 63% of our patients, since treatment of GER was followed by disappearance of the respiratory complaints in most of them. The combination of gastroesophageal scintiscanning and pH probe study improved the diagnostic accuracy. Pediatr Pulmonol 1987; 3208-213.
Long Term Follow-Up in Infants with Gastroesophageal Reflux
Journal of Pediatric Gastroenterology and Nutrition, 2005
Introduction: Determining the definitive diagnosis for abdominal pain in children remains a challenge for pediatricians. Rome Criteria for pediatric functional gastrointestinal disorders is a tool to be tested. Methods: Eighty-four consecutive patients with abdominal pain seen at a tertiary pediatric gastrointestinal outpatient clinic, from 1999 to 2000, were interviewed at presentation and followed up for 3 years. The interview methods included the assessment of symptoms defined by the Pediatric Rome Criteria. Results: Patients were classified as follows: Thirty-two patients did not fulfill the subtypes of Rome Criteria for abdominal pain: 25 were diagnosed with an organic disease and 7 referred total remission of the symptom after the first clinical assessment. Fifty-two patients (median age 9.3 years, min. 5 years, max. 13 y; 50% boys) fulfilled the Pediatric Rome Criteria for abdominal pain: 26 (50%) patients fulfilled the Criteria for functional abdominal pain, 24 patients (46.2%) for functional dyspepsia (18 for dismotility-like dyspepsia and 6 for ulcer-like dyspepsia) and, one patient (3.8%) for irritable bowel syndrome. Patients' evolution in the three-year follow-up period was the following: Nine patients left the abdominal pain Rome criteria and were classified in the functional constipation criteria. Seven patients, from those 32 who had not fulfilled the Rome Criteria, could be inserted in the irritable bowel syndrome during the follow up, based on the fact that the initial diagnosis of lactose intolerance, which had been confirmed by oral tolerance test, could not be maintained after excluding lactose from the patients' diet. Conclusion: Lactose intolerance, functional constipation and irritable bowel syndrome were conditions that might lead to a misinterpretation in the use of the Rome Criteria for pediatric abdominal pain. ROUTINE COMBINED ESOPHAGEAL IMPEDANCE AND pH MEASUREMENT IN CHILDREN.
Gastro-esophageal reflux in children: Symptoms, diagnosis and treatment
Journal of Pediatric …, 2011
Gastroesophageal reflux (GER) is the passage of gastric contents into the esophagus and is a normal physiologic process occurring several times per day in healthy individuals. In infants and toddlers, no symptoms allow to diagnose GERD or to predict response to therapy. In older children and adolescents, history and physical examination may be sufficient to diagnose GERD. Endoscopically visible breaks in the distal esophageal mucosa are the most reliable evidence of reflux esophagitis. Esophageal pH monitoring quantitatively measures esophageal acid exposure. The severity of pathologic acid reflux does not predict symptom severity or treatment outcome. Combined multiple intraluminal impedance and pH monitoring (MII-pH) measures both acid, weakly acid, non-acid and gas reflux episodes. MII-pH is superior to pH monitoring alone for evaluation of the temporal relationship between symptoms and GER. Barium contrast radiography is not useful for the diagnosis of GERD, but is useful to detect anatomic abnormalities. Tests on ear, lung and esophageal fluids for lactose, pepsin or lipid laden macrophages have all been proposed without convincing evidence. An empiric trial of acid suppression as a diagnostic test can be used in older children (> 10 years). Parental education, guidance and support are always required and usually sufficient to manage healthy, thriving infants with symptoms likely due to physiologic GER. Use of a thickened feed, by preference commercially available antiregurgitation formula, decrease visible regurgitation. Positional therapy brings additional benefit. Prone (beyond the age of sudden infant death syndrome) or left side sleeping position, and/or elevation of the head of the bed decrease GER. Chronic use of buffering agents or sodium alginate is not recommended for GERD since some have absorbable components that may have adverse effects with long-term use. Potential adverse effects of currently available prokinetic agents outweigh the potential benefits of these medications for treatment of GERD. Proton pump inhibitors (PPIs) are superior to histamine-2 receptor antagonists (H2RAs). Administration of long-term acid suppression without a diagnosis is not recommended. No PPI has been approved for use in infants < 1 year of age. The potential adverse effects of acid suppression, including increased risk of community-acquired pneumonias and gastrointestinal infections, need to be balanced against the benefits of therapy. Anti-reflux surgery is of benefit in selected children with chronic, relapsing GERD. Indications include failure of optimized medical therapy; dependence on long-term medical therapy; significant nonadherence with medical therapy; or pulmonary aspiration of refluxate.