8/10/2019 Gastroesophageal Reflux (Ing)
1/24
8/10/2019 Gastroesophageal Reflux (Ing)
2/24
GER : the involuntary passage of gastriccontents into the eshopaghus
Regurgitation : reflux dribbled efffortlesslyinto or out of the mouthVomiting : forceful expulsion of
gastrointestinal contents into theesophagus
8/10/2019 Gastroesophageal Reflux (Ing)
3/24
3 months old infant with regurgitation 4-6times a day
Sometimes through out from the noseWeight gain is OK (normal growth)Parenteral concern
Gastro Esophageal Reflux (GER)
8/10/2019 Gastroesophageal Reflux (Ing)
4/24
9 months old infant with regurgitation 4-6times a day since 3 months old
Refuse to feedSometimes with hematemesisFailure to thrive
Gastro Esophageal Relux Disease (GERD)
8/10/2019 Gastroesophageal Reflux (Ing)
5/24
6 years old child with sinusistisNot response to standard treatment
Referring for esophageal PH monitoringRelated to gastroesopageal refluxGood response to prokinetic drug
Spectrum of GERD
8/10/2019 Gastroesophageal Reflux (Ing)
6/24
GER and GERDInfant - Older Children - Adult
8/10/2019 Gastroesophageal Reflux (Ing)
7/24
FrequencyOf
Regurgitation
Age0-3 mo
Age4-6 mo
Age&-3 mo
Age10-12
mo
1-4
x/day
74% 65% 30% 4%
>4x/day 21% 10% 5% 0%Problem
?
24% 18% 16% 4%
8/10/2019 Gastroesophageal Reflux (Ing)
8/24
GER is a physiologic phenomenaPostprandial
Regurgitation occur everyday in 70%infants aged 4 months and 25% ofparents considered as a problem
GER resolve spontaneously in 55% infantsat 10 months of age and 81% by the ageof 18 months
8/10/2019 Gastroesophageal Reflux (Ing)
9/24
8/10/2019 Gastroesophageal Reflux (Ing)
10/24
Infants Older child /adolescent
- Feeding refusal- Recurrent vomiting- Poor weight gain- Iritability Colic- Apnea or apparent lifethreatening event(ALTE)- Arching or head-tilting(pseudo torticollis)
- Recurrent vomiting- Heartburn- Esophagitis- Dysphagia- Asthma- Reccurent pneumonia- Upper airway symptoms(e.g : chronic cough,hoarse voice)
8/10/2019 Gastroesophageal Reflux (Ing)
11/24
Incompetense LES (lower esophagealsphincter)
Delayed gastric emptyingAnatomic position of LES above thediaphragma in infancy
8/10/2019 Gastroesophageal Reflux (Ing)
12/24
Due to regurgitation respiratory symptomFailure to thrive - recurrent cough, wheezing,sinusitis - apnea, cyanotic spells
-stridor, hoarnessDue to esophagitis
Irritability Neurobehavioral symptom
Anorexia - abnormal posture andmovemenHematemesis - sandifer syndromemelena
8/10/2019 Gastroesophageal Reflux (Ing)
13/24
GER GERD Regurgitation with normalweight gain
No signs or symptoms ofesophagitis
No significant respiratorysymptom
No neurobehavioral
symptomps
Regurgitation with weight lossor inadequate weight gain
persistent irritability, pain ininfants, dysphagia, food refusal,hematemesis, melena, iron,deficiency anemia apnea and cyanosis, sleepdisturbance, wheezing orstridor, aspiation or reccurentpnemonia, chronic cough,hoarseness abnormal posturing, sandiferssyndrome
8/10/2019 Gastroesophageal Reflux (Ing)
14/24
GER
OdynophagiaHeartburn
Esophagitis
Fundoplication
Diagnosticprocedure
VisceralHyperalgesia
Refuse to eatAnorexiaEarly satiety
8/10/2019 Gastroesophageal Reflux (Ing)
15/24
Diagnosis is uncertainFailure of conservative treatment
Suspect of complications- failure to thrive- esophagitis
- respiratory complication- neurobehavioral symptomParenteral anxiety
8/10/2019 Gastroesophageal Reflux (Ing)
16/24
Barium mealEsophageal PH monitoring
ScintigraphyEndoscopy and biopsyManometry
Bioelectric impedance monitoring
8/10/2019 Gastroesophageal Reflux (Ing)
17/24
Gold standardFrequency and duration of reflux
episode can be mesuredCorrelation between reflux event andepisodic apnea
Chronic respiratory symptom infants canbe cause by freflux, even withoutvomiting (silent gastroesophageal reflux)
8/10/2019 Gastroesophageal Reflux (Ing)
18/24
To detect esophagitisGER with atypical manifestation sucj as
neurobbehavioral symptom
8/10/2019 Gastroesophageal Reflux (Ing)
19/24
Conservative treatmentAdequate burp
Thickening of formulaHypoallergenic formulapositioning
8/10/2019 Gastroesophageal Reflux (Ing)
20/24
Pharmacologic treatmentProkinetic : cisapride (0.2 mg/kg/dose 3-
4 doses)Acid supressor- cimetidine (20-40 mg/kg/day 3-4 doses)- ranitidine (4-8 mg/kg/day 2-3 doses)- omeprazole (1-3 mg/kg/day 1-2 doses)
surgical interventionfundoplication
8/10/2019 Gastroesophageal Reflux (Ing)
21/24
Infection Intestinal obstruction- otitis media - pyloric stenosis- gastroenteritis - malrotation- urinary tract infection - intussuception- meningitis
non obstructive GIdisease
Drug and toxic - gastroesophageal refluxMetabolic diseases - appendicitis
- gastritis
8/10/2019 Gastroesophageal Reflux (Ing)
22/24
Hypertrophic pyloric stenosis- same onset at 4 weeks old- expulsive vomiting- peristaltic wave- abdonimal mass- abdominal ultrasonographyIntestinal obstruction (anatomic defect)- antral web, stenosis and malrotation- barium meal
8/10/2019 Gastroesophageal Reflux (Ing)
23/24
GER is a common symptom occur ininfants and usually resolve spontaneously
with ageDiagnostic evaluation has to be done inpathologic GER to confirm the diagnosisand complications, including bariummeal, esophageal PH monitoring andendoscopy
8/10/2019 Gastroesophageal Reflux (Ing)
24/24
Treatment follow stepwise approach,starting fro conservative advice to
medical treatmentSurgical intervention (fundoplication)reserve only for for cases failed tooptimal medical treatment
Top Related