Related Experiment Videos
Conservative treatment of gastroesophageal reflux and hiatus hernia
Insights
Gastroesophageal reflux (GER) in infants often results from motility issues and is best treated with conservative measures like upright positioning and dietary adjustments. Surgical intervention is typically reserved for severe or persistent cases, particularly in older children with hiatus hernia.
Area of Science:
- Pediatric Gastroenterology
- Infant Health
- Digestive Disorders
Background:
- Gastroesophageal reflux (GER) is common in infants, often linked to esophageal motility and lower esophageal sphincter dysfunction.
- Vomiting is the primary symptom, usually responsive to conservative management.
- Hiatus hernia shares pathophysiological links with GER, with symptoms arising from concurrent reflux.
Purpose of the Study:
- To evaluate the efficacy of conservative treatment for GER and hiatus hernia in infants.
- To differentiate management strategies for GER and hiatus hernia based on age and severity.
- To assess the role of surgical versus conservative interventions.
Main Methods:
- Observation of 22 infants under one year with GER and hiatus hernia.
- Implementation of conservative therapy including upright positioning and dietary modifications.
- Surgical intervention for three patients and comparison with conservative outcomes.
Main Results:
- Conservative treatment was successful in 19 out of 22 infants, including those with reflux esophagitis.
- Pharmacological treatments (antacids, cimetidine, bethanechol) were deemed unnecessary or contraindicated.
- Surgical treatment was necessary for three infants and is indicated for hiatus hernia in older, especially neurologically impaired, children.
Conclusions:
- Conservative management, particularly upright positioning and dietary changes, is highly effective for infant GER and hiatus hernia.
- Surgical intervention is reserved for specific cases, primarily in older children with hiatus hernia.
- Distinguishing between GER and hiatus hernia is less critical than managing the reflux component effectively.
Abstract:
Gastroesophageal reflux is a frequent occurrence in infancy. Most frequently, gastroesophageal reflux (GER) is due to a functional disturbance and lack of coordination of esophageal motility and lower esophageal sphincter incompetence. Vomiting is the sole symptom in the great majority of infants and responds readily to postural and dietary therapy. A malposition and defective fixation of the cardia and abdominal esophagus is the pathophysiologic substrate of hiatus hernia. Although most patients with hiatus hernia have GER, hiatus hernia is only symptomatic with concomitant GER. Differentiation between hiatus hernia and GER should therefore be dispelled. Treatment of hiatus hernia with GER is directed towards placing the patient in an upright position, even 24 h a day if necessary in a patient severe symptoms. The duration of therapy can be weeks to months. Small, frequent feedings are of additional importance, while thickening of formula with cereals were found unnecessary. Over the last few years, we have been able to observe 22 infants under 1 year of age with GER and hiatus hernia. In 19 of these patients-among them also patients with reflux esophagitis-this conservative treatment regimen has been successful. Drugs like antacids or cimetidine to lower gastric were considered unnecessary. Bethanechol was considered contra-indicated due to its discomforting side effects in infants. Three patients have been treated surgically during this period of time. In contrast, hiatus hernia in older children-mainly mentally retarded children-with GER has to be treated surgically; conservative therapy is usually without effect. The rare clinical condition of brachyesophagus is considered a malformation and requires surgical therapy in every instance.