Separating Fact from Fiction in Pediatric Medicine: Infant Gastroesophageal Reflux – Science-Based Medicine

Lower oesophageal sphincter (LOS)

18. Janiszewska T., Czerwionka-Szaflarska M. IgE-dependent allergy-The intensification factor of gastroesophageal reflux in children and youth.

Impedance pattern typically observed during a reflux episode. In this example only the distal pH channel is shown which is located approximately 1.5 cm above the LOS. The retrograde oesophageal flow is indicated by arrow A. In this example the reflux reaches the proximal (highest, Z 1 ) channel.

Gastro-oesophageal reflux (GOR) is common in preterm and term infants [1] and is usually a self-limiting condition [2]. GOR is generally described as the effortless reflux of gastric contents into the oesophagus and is considered physiologic when the infant thrives and experiences no severe complications [3]. Symptoms may include sleep interruptions [4] frequent spitting up, posseting or vomiting, fussiness during or following feeds and constant or sudden crying, irritability and back arching, and is distressing for infants and stressful for parents especially when regurgitation is frequent [5, 6]. Parents will therefore seek support and education on interventions to help alleviate these symptoms [7]. Certain foods may be causing acid reflux, depending on your infant’s age.

pH probe. Your child will swallow a long, thin tube with a probe at the tip, which will stay in his esophagus for 24 hours. The tip measures levels of acids in his stomach. If your child has breathing problems, this test also can help the doctor tell if they’re the result of reflux.

The barium is mixed in with a bottle or other food. The health care professional will take several x-rays of your baby to track the barium as it goes through the esophagus and stomach.

If breast milk oversupply is a possible issue, lactation experts do have methods of dealing with this. The gold standard in diagnosing GERD, because it allows direct visualization and the ability to take tissue biopsies, is endoscopy. Inserting a scope down the esophagus is usually reserved for when a patient doesn’t respond to less invasive interventions, such as lifestyle modification, medications and dietary changes, and even then it is more about ruling out non-GERD causes of symptoms.

3.4. GERD and Extraintestinal Symptoms

There is a muscle at the lower end of the food pipe called the lower esophageal sphincter. This muscle relaxes to let food into the stomach and contracts to stop food and acid passing back up into the food pipe. Gastroesophageal reflux (GER) happens when the contents of the stomach wash back into the baby’s food pipe. It is defined as reflux without trouble, and usually resolves itself.

(1991 ) Gastroesophageal reflux, as measured by 24-hour pH monitoring, in 509 healthy infants screened for risk of sudden infant death syndrome. 24 Transient sphincter relaxations are increased during distension of the gastric fundus, and hyperalimentation of cystic fibrosis infants may be a predisposing factor. Delayed gastric emptying has been recognised as a risk factor for pathologically increased GOR. The information on gastric emptying in cystic fibrosis is not conclusive.

The high incidence figures in other studies are most likely to be due to selection bias, enrolling mainly patients with symptomatic reflux. An alternative explanation is that the incidence of pathological reflux in cystic fibrosis may increase with age. In babies who have reflux, the lower esophageal sphincter muscle is not fully developed and lets the stomach contents back up the esophagus.

Natural is better. Subluxations are to blame for everything. So forth and so on.

The therapy of pediatric GERD is based on a combination of conservative measures (i.e., lifestyle and dietary modifications), pharmacological and, rarely, surgical treatment. As stated above, the proper state-of the-art approach relies on the correct diagnosis and evaluation of GERD patients. From a clinical standpoint, it is useful to distinguish between infants/young children and older children/adolescent GERD management, since the clinical presentation, the choice of the therapy and the response to treatment significantly differs between the two groups. Below, we will review the current evidence-based approach in infant GERD and we will then briefly discuss the approach to older children/adolescents complaining of typical GERD.

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