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[Gastroesophageal reflux in children. An overlooked disease]
Insights
Gastro-oesophageal reflux (GER) in infants often leads to severe complications like oesophagitis and respiratory issues, including near-miss sudden infant death syndrome (SIDS). Surgical intervention is frequently necessary when conservative treatments fail, especially in infants with cerebral damage.
Area of Science:
- Pediatric Gastroenterology
- Neonatology
- Pediatric Surgery
Context:
- Gastro-oesophageal reflux (GER) is a common condition in infants.
- GER can lead to significant complications, including oesophagitis, respiratory problems, and events resembling near-miss sudden infant death syndrome (SIDS).
- The study evaluated treatment outcomes in a cohort of pediatric patients with GER.
Purpose:
- To assess the efficacy of conservative versus surgical management for gastro-oesophageal reflux in pediatric patients.
- To identify factors associated with poor treatment outcomes in GER patients.
- To establish guidelines for the management of GER in infants presenting with respiratory symptoms or near-miss SIDS events.
Summary:
- This study analyzed 25 pediatric patients with GER, finding that 11 had cerebral damage, 15 showed oesophagitis symptoms, and 18 experienced respiratory issues, including 6 with apnoea, cyanosis, and bradycardia (near-miss SIDS).
- Only 2 patients improved with conservative treatment; the rest underwent surgery, which was ineffective in 30% of cases.
- Ineffective surgical outcomes were linked to cerebral damage or oesophageal atresia.
Impact:
- Conservative management for GER should be attempted for at least three months before considering surgery.
- Surgery should be reserved for cases unresponsive to prolonged conservative treatment.
- Infants with unexplained chronic respiratory symptoms or apnoeic episodes suggestive of near-miss SIDS require evaluation for GER.
Abstract:
In a material of 25 patients with gastro-oesophageal reflux (GER), 11 had cerebral damage, 15 had symptoms of oesophagitis and 18 had respiratory problems including here six cases of apnoea with cyanosis and bradycardia resembling near-miss sudden infant death syndrome (SIDS). Only two of the children recovered acceptably on conservative treatment and the remainder were submitted to operation. Operation had insufficient effect in 30%. Cerebral damage or atresia of the oesophagus were present in all of the patients in whom operation was without effect. All children with symptom-producing GER should first be submitted to conservative treatment for at least three months and operation should be offered in cases where this treatment fails. Children with chronic or recurrent respiratory symptoms without other explanation and all children with episodes of apnoea and near-miss SIDS should be examined for the presence of GER.