Friday, October 22, 2010

Gastroesophageal Reflux in Infants

This is defined as the passage of gastric contents to the esophagus. Once the food reaches the stomach this will be mixed with acidic enzymes that help break down the food in smaller pieces. If the contents of the stomach goes to the esophagus this may cause problems in some babies, because the lining of the esophagus is not designed to hold acidic substances. Most babies have some kind of gastroesophageal reflux but are not bothered by it, they are what you call "happy spitters". Once the babies show symptoms this is called gastroesophageal reflux disease.
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
  • coughing
  • regurgitation
  • apnea
  • wheezing
  • hoarseness
  • stridor
  • abnormal neck posturing (Sandifer syndrome)
  • refusal to eat

Diagnostic Approaches

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

Treatment options:

  • 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

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