gastroesophageal%20reflux%20disease%20in%20children
GASTROESOPHAGEAL REFLUX DISEASE IN CHILDREN

Gastroesophageal reflux is categorized as a disease [gastroesophageal reflux disease (GERD)] when reflux is associated with warning signs &/or complications, & requires further evaluation.

It is more common in formula-fed infants than in purely breastfed infants.

There is increased incidence in infants at 4 months of age.

Definition

  • Gastroesophageal reflux (GER) is the normal physiologic passage of gastric contents into the esophagus
  • Gastroesophageal reflux is categorized as a disease [gastroesophageal reflux disease (GERD)] when reflux is associated with warning signs &/or complications, & requires further evaluation

Epidemiology

  • Frequency of physiologic regurgitation decreases as a child reaches the 1st year of life, & eventually resolves by 12-18 months of age
  • More common in formula-fed infants than in purely breastfed infants
  • Increased incidence in infants 4 months of age

Etiology

  • Produced by various mechanisms such as frequent occurrence of transient relaxation of the lower esophageal sphincter (LES), pressure abnormalities in the lower esophageal sphincter
    • Other factors in the pathology of gastroesophageal reflux disease include poor esophageal clearance, delayed gastric emptying time, hiatal hernia 
  • Genetic predisposition have been associated with the diagnosis of gastroesophageal reflux disease

Signs and Symptoms

  • Infants <12 months of age:
    • Refusal to eat
    • Recurrent vomiting
    • Poor weight gain
    • Irritability
    • Sleep disturbance
    • Respiratory symptoms (coughing, wheezing, choking)
    • Upper airway symptoms (prolonged/chronic cough, hoarseness) 
  • Children ≥1 year of age & adolescents:
    • Abdominal pain/heartburn
    • Recurrent vomiting
    • Dysphagia
    • Asthma
    • Recurrent pneumonia

Warning Signs

  • Gastrointestinal tract bleeding (hematemesis, hematochezia)
  • Abdominal tenderness/distension, palpable abdominal mass
  • Bilious vomiting
  • Projectile vomiting
  • Fever
  • Lethargy, irritability
  • Hepatosplenomegaly
  • Seizures
  • Bulging fontanelle
  • Positive for genetic/metabolic syndrome

Risk Factors

  • Neurological impairment
  • Obesity
  • History of esophageal atresia repair
  • Hiatal hernia
  • Achalasia
  • Chronic respiratory disease (idiopathic interstitial fibrosis, cystic fibrosis, bronchopulmonary dysplasia)
  • Lung transplantation
  • Preterm infants
  • Certain genetic disorders
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