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[Current trends in the treatment of reflux esophagitis in childhood]
Insights
Managing pathological gastro-esophageal reflux in infants often involves conservative measures. Surgery is indicated for persistent symptoms or severe complications like hiatal hernia or esophagitis.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Esophageal Disorders
Context:
- Pathological gastro-esophageal reflux presents challenges, especially with anatomical abnormalities like cardio-hiatal malformation or short esophagus.
- Infant chalasia of the esophagus, characterized by lower esophageal sphincter (LES) hypotonia, may occur without apparent morphological changes.
Purpose:
- To outline management strategies for pathological gastro-esophageal reflux in infants.
- To define indications for surgical intervention versus conservative treatment.
Summary:
- Conservative management, including dietary changes, postural adjustments, and medications, is the initial approach for gastro-esophageal reflux, typically not exceeding six weeks.
- Surgical correction is recommended for cases involving hiatal hernia, severe esophagitis, peptic stenosis, or persistent symptoms unresponsive to conservative therapy.
- Surgical techniques like Nissen fundoplication or the Belsey-Mark IV procedure aim to restore LES function effectively.
Impact:
- Provides clear guidelines for managing infant gastro-esophageal reflux, differentiating between conservative and surgical approaches.
- Highlights the importance of timely surgical intervention for specific complications to improve patient outcomes.
- Contributes to the understanding of treatment efficacy for various forms of pediatric gastro-esophageal reflux.
Abstract:
A problem of some complexity is the management of pathological gastro-esophageal reflux due to the presence of cardio-hiatal malformation, malposition of the cardia and gastric tuberosity, a congenitally short esophagus, and the like. Sometimes, however, there is no demonstrable morphological aleration and the condition, characterized by primitive hypotonia of the LES, goes under the name of infant chalasia of the esophagus. The general policy is to try first a conservative treatment consisting of dietary and postural measures and the administration of metoclopramide and d;ugs that protect the esophageal mucosa; this stage, however, should not be prolonged beyond 6 weeks. The presence of gastro-esophageal reflux associated with hiatal hernia; the presence of severe esophagitis or peptic stenosis of the esophagus and the persistence of symptoms after an adequate period of conservative therapy constitute as many indications for surgical correction. Good results can be obtained by restoring or strengthening the failing function of the LES, as is done quite successfully with funduplication after Nissen or with method of Belsey-Mark IV.