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Gastroesophageal Reflux Disease

more about Gastroesophageal Reflux Disease

Indigestion, heartburn, or "reflux"

  • Food is carried from the mouth to the stomach by a tube called the esophagus.  Between the end of the esophagus and stomach there is a muscular valve called a sphincter.  The sphincter prevents stomach contents (food, acid, etc.) from going back into the esophagus.  Gastroesophageal reflux is a syndrome in which the stomach contents return to the esophagus and cause symptoms or medical problems.  This condition is extremely common in newborns and infants.

  • 85% of patients have symptoms during the 1st week of life, 10% by 6 weeks of life.  Common symptoms are:
    1. Vomiting
    2. Feeding difficulties
    3. Pallor
    4. Poor weight gain
    5. Fever
    6. Diarrhea
    7. Belching
    8. Failure to Thrive
  • Heartburn usually 30-60 minutes after eating
  • Heartburn after lying down or sleeping
  • Relief of symptoms from antacids
  • Chronic dry cough or wheezing
  • Chest pain (not associated with exercise)

  • Essentially, increased relaxation of the lower esophageal sphincter (i.e., chalasia or relaxation)
  • Factors contributing to increased relaxation of the lower esophageal sphincter:
    1. Immaturity
    2. Esophageal disease
    3. Obstructive lung disease
    4. Increased abdominal pressure (overeating, coughing, crying)
  • Reflux symptoms occur because (1) the esophageal sphincter is not working properly and acid refluxes back into the esophagus, (2) acid that gets refluxed into the esophagus is not neutralized, or (3) stomach contents are not emptying properly and things "back upward" to the esophagus.

  • Endoscopy -- scope passed from mouth into esophagus.  It shows a red and irritated esophagus
  • Barium swallow -- sometimes helpful
  • pH monitoring of esophagus -- done rarely if diagnosis is unclear
  • Esophageal manometry -- measures esophageal pressures.  Also done only if diagnosis is unclear.
  • Gastric scintiscans

  • Position therapy
    1. Keep prone (lie baby on the face)
    2. Raise the head and keep the baby in an upright position after feeding
  • Thickening formula
  • Small, frequent feeding
  • No meal after 7 pm
  • Medications:
    1. Antacids, e.g., Maalox may help milder cases (may need to be used every four hours)
    2. H2 receptor blockers (e.g., Zantac, Tagamet)
    3. Proton pump inhibitors (e.g., Prilosec) are the strongest medications for suppressing acid
    4. Reglan (metochlopramide) makes food move forward down gastrointestinal tract.
  • Surgery if all medications fail and strictures recur or severe inflammation of esophagus is present.
    1. Nissen fundoplication. 
    2. Percutaneous gastrojejunostomy

  • 60% improve by age 2
  • Others may continue to have symptoms until at least 4 years of age.

  • Esophagitis
  • Peptic ulcer
  • Non-ulcer dyspepsia
  • Achalasia

more about Gastroesophageal Reflux Disease

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