Practice Essentials, Background, Etiology And Pathophysiology

Barrett esophagus, a complication of GERD, greatly increases the patient’s risk of adenocarcinoma As with esophageal stricture, the presence of Barrett esophagus indicates the need for surgical consultation and treatment (usually surgical fundoplication). For many years, gastroesophageal reflux during infancy and childhood was thought to be a consequence of absent or diminished LES tone. However, studies have shown that baseline LES pressures are normal in pediatric patients, even in preterm infants. Laryngeal tissues are exquisitely sensitive to the noxious effect of acid, and studies support a significant relationship between laryngeal inflammatory disease (manifested by hoarseness, stridor, or both) and gastroesophageal reflux.

Intraluminal esophageal electrical impedance: For detecting acid and nonacid reflux by measuring retrograde flow in the esophagus; normal values have not been determined in the pediatric age group. Keep in mind that stomach positioning should only be used when your baby is awake and being observed. Because of the risk of SIDS , even kids with reflux should be put to sleep on their back unless your pediatrician recommends otherwise. Gastroesophageal reflux is most commonly seen in infancy, with a peak at age 1-4 months. However, it can be seen in children of all ages, even healthy teenagers.

Some children may also have weak valves that are particularly sensitive to certain foods and beverages or inflammation in the esophagus that’s causing the problem. The symptoms of gastroesophageal reflux are most often directly related to the consequences of emesis (eg, poor weight gain) or result from exposure of the esophageal epithelium to the gastric contents. The typical adult symptoms (eg, heartburn, vomiting, regurgitation) cannot be readily assessed in infants and children. Conversely, no conclusive clinical evidence supports a link between gastroesophageal reflux and other supraesophageal problems, including otalgia, recurrent otitis media, and chronic sinusitis.

Decreased gastric compliance is believed to lead to LES relaxation at lower intragastric volumes in infants. This aspect, in conjunction with abdominal wall muscle contraction (if it occurs during periods of LES relaxation) propels refluxate into the esophagus, with subsequent check out your url regurgitation. Barium swallow or upper GI series. This is a special X-ray test. Your child will drink a chalky substance to highlight his esophagus, stomach, and upper part of his small intestine. It can show if anything is blocking or narrowing these areas.

Keep in mind that Zantac is the only acid reflux medication that is FDA approved to treat reflux in infants But other medications are often used off-label for younger children, including Axid and Prevacid. Some babies spit up more when they drink large amounts in one sitting. Changing your baby’s feeding schedule so that he eats smaller amounts more often can alleviate his reflux symptoms. The image is a representation of concomitant intraesophageal pH and esophageal electrical impedance measurements. The vertical solid arrow indicates commencement of a nonacid gastroesophageal reflux episode (diagonal arrow). The vertical dashed arrow indicates the onset of a normal swallow.

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