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Gastro-oesophageal reflux in children
1Emma Children's Hospital AMC, Amsterdam, The Netherlands.
Insights
Gastro-oesophageal reflux in children differs from adults, often resolving by age two. Treatment focuses on gastric thickening and positioning, with adult therapies used for complicated cases.
Area of Science:
- Pediatrics
- Gastroenterology
Background:
- Gastro-oesophageal reflux (GOR) in children presents unique challenges compared to adults.
- A significant portion of GOR episodes in infants stem from transient increases in abdominal pressure exceeding lower oesophageal sphincter (LOS) pressure.
Purpose of the Study:
- To outline the distinct pathophysiology and age-specific management of GOR in children.
- To differentiate GOR treatment in uncomplicated versus complicated pediatric cases.
- To address diagnostic challenges and potential complications of GOR in infants and children.
Main Methods:
- Review of pathophysiological mechanisms of GOR in pediatric populations.
- Analysis of age-dependent resolution of GOR-related abnormalities.
- Comparison of treatment strategies for uncomplicated GOR, complicated GOR, and related conditions like eosinophilic oesophagitis.
Main Results:
- The primary pathophysiological cause of GOR in children (increased abdominal pressure) typically resolves by 1.5-2 years of age.
- Conservative treatments like gastric content thickening and anti-Trendelenburg positioning are effective for uncomplicated GOR in young children.
- For complicated GOR, treatments mirroring adult protocols (H2 antagonists, proton-pump inhibitors) show similar efficacy.
Conclusions:
- GOR management in children under two years requires minimal intervention unless complications arise.
- Complicated GOR in children necessitates treatment comparable to adults, with effective pharmacological options available.
- While rare, serious complications like aspiration in infants and the need to consider food allergies in eosinophilic oesophagitis warrant attention.
Abstract:
Gastro-oesophageal reflux in children is different in several aspects from in adults. Pathophysiologically, 50% of reflux episodes are due to increased abdominal pressure which overcomes the lower oesophageal sphincter pressure. This pathophysiological abnormality disappears in children at the age of 1.5-2 years. Treatment is therefore different and aimed at thickening the gastric contents to inhibit reflux (Nutrition, Gaviscon, Algicon). The child is placed in the anti-Trendelburg position when asleep. No further investigation or intensification of treatment is necessary in young children under the age of 2 years unless complications are present. With complicated gastro-oesophageal reflux, treatment in children is comparable to that in adults; the effects of H2 antagonists and proton-pump inhibitors are identical. Long-term complications of gastro-oesophageal reflux are rare. In the near sudden death syndrome or acute life-threatening events in infants due to total sphincter relaxation aspiration is possible and should be prevented. Optimal treatment and monitoring are mandatory. In mentally handicapped children rumination is more prominent than gastro-oesophageal reflux. It is difficult to distinguish between vomiting, regurgitation and rumination. Treatment of oesophagitis might improve quality of life. When clear eosinophilic oesophagitis is observed food allergy should be considered and appropriately treated.