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Gastroesophageal reflux in infants and children
1Section of Pediatric Gastroenterology, Mayo Clinic Rochester, Minnesota 55905, USA.
Insights
Gastroesophageal reflux in children presents differently by age. Diagnosis involves history, pH probe, and potentially endoscopy, with management tailored to severity, ranging from behavioral changes to surgery.
Area of Science:
- Pediatric Gastroenterology
- Digestive Health
Background:
- Gastroesophageal reflux (GER) is a common pediatric issue leading to specialist referrals.
- GER's presentation and mechanisms vary significantly with a child's age.
Purpose of the Study:
- To outline the diagnostic and management strategies for pediatric gastroesophageal reflux.
- To present an algorithm for approaching GER diagnosis in children.
Main Methods:
- Diagnosis relies on patient history, confirmed by pH probe.
- Endoscopy assesses complications like esophagitis and strictures.
- Contrast studies rule out anatomical obstructions.
Main Results:
- GER complications include esophagitis, strictures, and failure to thrive; others like apnea are debated.
- Treatment varies from conservative measures (behavioral, medications) to surgery for severe cases.
- GER beyond infancy often becomes chronic, requiring long-term management.
Conclusions:
- An age-dependent approach is crucial for diagnosing and managing pediatric GER.
- A structured diagnostic algorithm aids in effective patient care.
- Long-term management strategies are often necessary for chronic pediatric GER.
Abstract:
Gastroesophageal reflux is a common pediatric complaint and a frequent reason for pediatric patients to be referred to a gastroenterologist. The pathophysiology and clinical manifestations of this disorder differ according to patient age. The diagnosis is suggested by the history and can be confirmed by a pH probe. In the appropriate clinical setting, anatomic obstruction may need to be ruled out by contrast study. Endoscopy is used to assess associated complications, including esophagitis, esophageal strictures, Barrett's transformation, and failure to thrive. Other complications are controversial, including pulmonary disease, apnea, and sudden infant death syndrome. Treatment depends on the severity of disease. Conservative therapy includes behavorial modifications, prokinetic agents, and H2 antagonists. Proton pump inhibitors are generally reserved for refractory esophagitis. Surgical treatment may be necessary for gastroesophageal reflux resistant to medical management or for severe complications. Gastroesophageal reflux beyond infancy tends to be chronic; therefore, lifelong behavioral modifications or repeated courses of medical therapy may be necessary. An algorithm for the suggested diagnostic approach to gastroesophageal reflux is presented herein.