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Gastroesophageal reflux in children. Clinical profile, course and outcome with active therapy in 126 cases
Insights
Gastroesophageal reflux (GER) in children often presents with regurgitation and pain, but most infants become symptom-free with active therapy by 18 months. Esophagitis is a key factor influencing outcomes, highlighting the need for early investigation.
Area of Science:
- Pediatric Gastroenterology
- Clinical Medicine
- Infant Health
Background:
- Gastroesophageal reflux (GER) is a common condition in infants and children.
- GER can manifest with various symptoms including regurgitation, pain, feeding difficulties, and respiratory issues.
- Understanding the clinical course and therapeutic outcomes is crucial for managing pediatric GER.
Purpose of the Study:
- To present the clinical profile, course, and therapeutic outcomes of 126 infants and children diagnosed with GER.
- To identify factors influencing the outcome of GER in pediatric patients.
- To emphasize the importance of early investigation and tailored therapeutic strategies for GER.
Main Methods:
- Retrospective analysis of 126 infants and children diagnosed with GER.
- Median age at diagnosis was 2.5 months, with a follow-up period of 1.5 to 3.5 years.
- Therapeutic interventions included conservative measures, pharmacotherapy (antacids, bethanechol, cimetidine), and surgery (fundoplication).
Main Results:
- Common symptoms included regurgitation/rumination (99%), esophageal pain indicators (49%), respiratory symptoms (42%), failure to thrive (18%), and hematemesis (18%).
- Most patients (81%) became symptom-free by 18 months; 17% underwent fundoplication with good outcomes.
- Esophagitis was a significant determinant of outcome; surgery was indicated for specific complications or refractory cases.
Conclusions:
- Gastroesophageal reflux causes significant morbidity in infants but is generally self-limiting with active management.
- Distinctive clinical signs warrant detailed investigation and aggressive therapeutic approaches.
- Selective early endoscopy is important for identifying esophagitis and guiding treatment for improved outcomes.
Abstract:
A clinical profile and the course and outcome with therapy of 126 infants and children with gastroesophageal reflux (GER), diagnosed at a median age of 2.5 months and followed for 1.5 to 3.5 years is presented. Features included repeated regurgitation or rumination (99%), signs suggesting esophageal pain (49%, excessive crying "colic," sleep disturbance, Sutcliffe-Sandifer syndrome, respiratory symptoms 42%), failure to thrive (18%), and minor hematemesis (18%). Feeding problems and maternal distress were common, associated with child abuse in four cases. Therapy was initially conservative (posture, thickening of feeds, antacids, bethanechol), augmented by cimetidine in those with proven esophagitis (n = 34, 0.27%). Most (81%) were symptom-free by 18 months of age (55% by 10 months of age); 17 percent had fundoplication with good results; 2 percent have persisting symptoms beyond 2 years of age (1% failed surgery). No deaths were recorded. Surgery was performed for recurrent apneas/aspiration (6%), refractory esophagitis or stricture (5%), and failed medical management (7%). Esophagitis was a significant determinant to outcome, and the importance of selective early endoscopy is emphasized. GER is a cause of considerable morbidity in infants but, with active therapy, is self-limiting in the majority. Certain distinctive clinical signs indicate those patients who require detailed investigation and to whom more aggressive therapeutic efforts should be directed.