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Gastroesophageal reflux in children
1Royal Hospital for Sick Children, St. Michael's Hill, Bristol, BS2 8BJ.
Insights
Gastroesophageal reflux (GER) in children, especially those with neurological impairments, can cause significant health issues. Diagnosis and treatment strategies, including pH monitoring and medications like omeprazole, are crucial for managing this condition.
Area of Science:
- Pediatrics
- Gastroenterology
- Clinical Medicine
Background:
- Gastroesophageal reflux (GER) is a significant cause of morbidity and failure to thrive in children, particularly those with neurological impairments.
- Clinical presentations of GER vary widely, from overt symptoms like regurgitation and vomiting to silent reflux, apnea, and aspiration pneumonia.
- Diagnosis of GER can be challenging, with 24-hour esophageal pH monitoring considered the gold standard, while barium radiography and endoscopy aid in identifying anatomical issues and esophagitis.
Purpose of the Study:
- To review the diagnosis and established therapeutic strategies for gastroesophageal reflux disease (GERD) in pediatric patients.
- To highlight the effectiveness of various treatment modalities, including lifestyle modifications, prokinetic agents, and acid suppressants.
Main Methods:
- Review of established diagnostic tools for GER, including 24-hour esophageal pH monitoring, barium radiography, and endoscopy.
- Discussion of therapeutic interventions ranging from conservative measures to pharmacological treatments.
Main Results:
- Conservative measures like infant positioning and thickened feeds are beneficial for uncomplicated GER.
- Prokinetic agents (cisapride, metoclopramide, domperidone) and H2-receptor antagonists (ranitidine, cimetidine) are effective in managing GER and associated esophagitis.
- Omeprazole demonstrates efficacy in treating GER-esophagitis resistant to H2 antagonist therapy, even in high-risk pediatric populations.
Conclusions:
- Effective management of GER in children involves a combination of appropriate diagnostic methods and tailored therapeutic approaches.
- Pharmacological interventions, including H2-receptor antagonists and proton pump inhibitors like omeprazole, play a vital role in managing refractory GERD and esophagitis in pediatric patients.
Abstract:
Gastroesophageal reflux (GOR) is a major cause of morbidity and failure to thrive particularly in neurologically impaired children. Clinical manifestations of GOR in children range from regurgitation, food refusal, irritability, failure to thrive, hematemesis, wheezing and aspiration pneumonia, apnoea and apparent life threatening events in infants to clinically silent reflux. Although, no one test is always best to diagnose GOR, 24 hour esophageal pH monitoring remains the 'gold standard' for diagnosis. Barium radiography is useful for the diagnosis of associated anatomical abnormalities and endoscopy enables a histological diagnosis of esophagitis. Therapy for gastroesophageal reflux disease is now well established. Proper positioning of the baby and thickening of feeds is beneficial in uncomplicated GOR. Prokinetic agents like cisapride should be tried if dietary management and antacids are ineffective. Metoclopramide or domperidone may be tried in neurologically impaired children. H2-receptor antagonists are indicated in GOR complicated by esophagitis. Ranitidine is regarded to be more potent. Cimetidine has additional spectrum of adverse effects and sufficient information is not available on famotidine. Omeprazole has been shown to be effective in treating GOR-esophagitis resistant to H2 antagonist therapy even in high risk patients.