Infants with GER are thriving children and do not have recurrent agitation or forceful ejection of breast milk/formula. They maintain good weight gain.
Recognized GERD-promoting conditions highlighted by the most recent European and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN and NASPGHAN) guidelines are listed in the paragraph 3.4 . In these populations, the likelihood of severe GERD is much higher and can predict a worse outcome of the disorder, defining an â€œat riskâ€ group of patients in which further investigation and management is advisable. Acquired (secondary) GERD can also occur with a number of congenital anomalies, including congenital diaphragmatic hernia, absence of diaphragmatic crura, omphalocele, gastroschisis, esophageal atresia and intestinal malrotation, with reported incidences as high as 50-84% .
In another study by Waring et al., 255 adult patients with GERD and 154 â€œnon-refluxersâ€ were given questionnaires asking them to recall childhood symptoms of GERD. The study showed that adults with GERD were more likely to have experienced GER symptoms during childhood . These studies suggest that in a significant percentage of children with GERD, symptoms may persist throughout the adolescence until the adulthood. However, large longitudinal studies are still needed to prove this relation.
Gastroesophageal Reflux (GER and GERD) in Infants and Children
Anti-secretory drugs are the backbone therapy for GERD patients. Both histamine-2 receptor antagonists (H 2 RAs), and proton pump inhibitors (PPIs) are approved for clinical use in the pediatric population, while, in infants aged 1 year, no proton pump inhibitor formulation is approved, at present.
Nielsen et al showed that 56% of children with severe GERD were found to have CMPA on double-blind or open challenge . Subsequently, Yukselen and Celtik studied the frequency of food allergy in children below five years of age with poor response of GERD symptoms to pharmacological treatment and found a prevalence of food allergy of
Some consider the small reservoir capacity of the infant’s esophagus to be a predisposing factor to vomiting. The causes and risk factors for gastroesophageal reflux in children are frequently multifactorial. Children with reflux rarely need surgery. It may be an option for babies or children who have severe reflux that causes breathing problems or keeps them from growing.
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. In pediatric gastroesophageal reflux disease (GERD), immaturity of lower esophageal sphincter function is manifested by frequent transient lower esophageal relaxations, which result in retrograde flow of gastric contents into the esophagus. Gastroesophageal reflux happens when food and stomach acid flow from the stomach back into the esophagus.
Medical management with PPIs is the usual first course of treatment. PPIs have a higher rate of medication compliance and may better aid in regression of existing damage to the esophagus as well as symptom improvement.
Diagnosing GERD in children
Severe cases of GERD that do not respond to medical therapy may require surgery. Treatment of GERD in children and adolescents is similar to that used for adults. If your child has persistent symptoms or worsening problems, seek medical evaluation by a doctor who will evaluate the symptoms. X-rays test where the child swallows contrast to evaluate the passage of food or liquid.