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Gastro-oesophageal reflux, hiatus hernia and the radiologist, with special reference to children
Insights
Gastro-oesophageal reflux in infants can cause peptic oesophagitis and strictures. Prompt diagnosis and radiological evaluation are crucial for effective management of this common condition.
Area of Science:
- Pediatric Gastroenterology
- Radiology
Background:
- Gastro-oesophageal reflux (GOR) is a common condition in infants, potentially leading to peptic oesophagitis and stricture formation.
- The inferior oesophageal sphincter (IOS) is the primary barrier to reflux, but it is underdeveloped in neonates, predisposing them to reflux.
- Symptoms like vomiting, anemia, and failure to thrive in infants warrant suspicion of GOR.
Purpose of the Study:
- To describe the anatomy of the oesophago-gastric junction and its role in GOR.
- To outline the diagnostic approach for peptic oesophagitis in infants, focusing on radiological examination.
- To emphasize the importance of recognizing GOR as a primary cause of peptic oesophagitis.
Main Methods:
- Detailed description of the anatomy of the oesophago-gastric junction, including the IOS.
- Radiological examination techniques for diagnosing GOR, involving prone positioning, swallowing, Trendelenburg position, and abdominal compression.
- Clinical correlation to guide repeat radiological examinations when findings are suggestive but initial results are negative.
Main Results:
- The IOS is a key functional barrier, but its weakness in neonates leads to frequent reflux.
- Peptic oesophagitis is primarily caused by GOR, although hiatus hernia can contribute.
- Radiological examination is a quick, simple, convenient, and safe diagnostic tool for GOR, provided its limitations are understood.
Conclusions:
- GOR is a significant cause of peptic oesophagitis and strictures in infants, presenting with specific symptoms.
- Careful radiological examination, including specific patient positioning and maneuvers, is essential for diagnosis.
- Pyloric stenosis must be excluded, and repeat examinations are recommended if clinical suspicion remains high despite negative initial findings.
Abstract:
Gastro-oesophageal reflux can lead to peptic oesophagitis and stricture formation. This is particularly true in infants in whom the condition should be suspected if the patient presents with vomiting, anaemia and failure to thrive. The anatomy of the oesophago-gastric junction is described. The inferior oesophageal sphincter is the main barrier to reflux, and marks the functional junction between oesophagus and stomach. It is under nervous and hormonal control. It is weak in the neonate who therefore frequently refluxes. An hiatus hernia can cause problems due to its bulk but the main problem of peptic oesophagitis is due to gastro-oesophageal reflux. The radiological examination should be carried out carefully with the patient swallowing in a prone position. The patient should be put in the Trendenlenberg position and compression applied to the abdomen. Reflux is intermittent and a negative examination should be repeated if the clinical findings suggest a diagnosis of peptic oesophagitis. Associated pyloric stenosis should always be excluded. Radiological examination of the gastro-oesophageal junction remains the quickest, simplest, and most convenient and safe technique as long as its limitations are appreciated.