Gastroesophageal Reflux Disease
What is it?
Gastro-oesophageal reflux occurs when the liquid contents of the stomach refluxes flow back into the oesophagus.
How common is it?
Gastro-oesophageal reflux in infants is common. Nearly 50% of infants have daily regurgitation by the age of 2 months. Typically, infants with gastro-oesophageal reflux will improve as they get older especially when they are in the weaning process.
What are the signs and symptoms?
The clinical symptoms can vary with age. In infant, it can cause apnoea (stop breathing), chronic cough, vomiting, gulping, back arching, discomfort during feeding, hiccupping, and frequent stop and start during feeding time. In older children, heartburn, nausea, chest and throat discomfort are common.
What are the causes?
This is usually caused by immaturity of the lower esophageal sphincter. Over time the lower oesphageal sphincter will become more mature and competent, and 90% of infants with reflux will improve when they reach their first birthday. Other causes include food protein allergy or intolerance, sugar intolerance (lactose/fructose/sucrose) and overfeeding. Hiatus hernia, anxiety, obesity and Helicobacter Pylori are also important causes for gastro-oesophageal reflux.
How is it diagnosed?
A detailed history is often sufficient to reach diagnosis of gastro-oesophageal reflux. It can be diagnosed with an abdominal ultrasound scan. An experienced radiologist will be able to see the flow of the refluxate from the stomach into the oesophagus during the feeding time. However, a negative abdominal ultrasound scan finding does not rule out reflux as it is only capture the reflux at real time. A 24-hour pH study, Bravo capsule and pH impedance study can be used to diagnose gastro-oesophageal reflux. Sometimes a barium swallow is needed to check for hiatus hernia or aspiration.
What is the treatment?
It is often can be managed conservatively with appropriate positioning, frequent winding and nursing at an angle of 30 degrees. Sometimes milk thickeners such as Gaviscon and Carobel can be helpful. Anti-reflux medications such as proton pump inhibitors (Omeprazole, Lansoprazole, Esomeprazole) may also be needed in severe gastro-oesophageal reflux.
Calculation of feeding volume is important to ensure that the child is not overfed.
Important notes:
Children with reflux can be caused by food protein intolerances or allergies. Sugar intolerance such as fructose is another important cause for reflux. Therefore, it is important to consider a defined brief period exclusion diet such as dairy, wheat, soya, egg and fructose.
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