Reflux results from the transient relaxation of the lower esophageal sphincter.
Signs and symptoms of GERD (Gastroesophagel Reflux Disease):
- recurrent vomiting
- poor weight gain
- weight loss
- difficulty swallowing
- abdominal pain
- chest pain
- abnormal neck posturing (Sandifer syndrome)
- refusal to eat
1. Most of the diagnosis of GERD/GER can be obtained by a careful history and physical examination
2. Upper Gastrointestinal Series (UGIS) this is a series of abdominal x-rays which can rule out any anatomical reason for the symptoms
3. Esophageal pH monitoring-this is a useful, valid and reliable test to see the correlation of reflux with the symptoms. We usually hospitalize the baby and insert a probe close to the lower esophageal sphincter and monitor the heart rate, respiratory rate and oxygenation. This is also used to assess the response to treatment.
4. Endoscopy and Biopsy - this is done by a gastroenterologist, they put a tube down the esophagus and get a tissue sample to check if there is any type of inflammation that has been occurring in the area.
5. Empiric Medical Therapy - A trial of medication can be useful if the GER is causing and specific symptoms
- there is evidence to support a trial of a hypoallergenic formula for 1-2 weeks may work
- may add 1 tsp of rice cereal to an ounce of formula this will of course will increase the caloric density of the formula
- positioning the infant, elevate the head at a 45 degree angle when sleeping and do nor move the baby too much after feeding
- Acid-Suppressant therapy-this blocks the production of acid which in turn relieves the symptoms
- Prokinetic therapy - this reduces the incidence of regurgitation and vomiting but with the multiple side effects of the medications this has not been readily available in the market
- surgical therapy - this is the last resort which generally results in a favorable outcome