Gastro-esophageal reflux in pediatrics; (patho)physiology and new insights in diagnostics and treatment

Pediatric Gastroenterology and Nutrition, Emma Children Hospital/, Academy Medical Centre, Amsterdam, The Netherland.
Minerva pediatrica (Impact Factor: 0.43). 02/2012; 64(1):101-19.
Source: PubMed


GER is the passage of gastric contents into the esophagus and is referred to as GER disease (GERD) when GER causes troublesome symptoms and/or complications. GERD in infants and children is sometimes difficult to diagnose and even more difficult to treat. The diagnosis of GERD is hampered by the fact that GER symptoms such as irritability and crying, feed refusal and regurgitation are common problems in infants and these symptoms are not specific for GERD. Diagnostic criteria for the objective diagnosis of GERD with commonly used diagnostic tests such as pH-metry, pH-impedance monitoring and endoscopy are poorly or not defined. In this review the current understanding of (patho)physiology of GERD, clinical history in infants and children, new insights in diagnostic modalities and the role of non-pharmacological and pharmacological interventions are discussed.

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Available from: Taher Omari, Aug 27, 2014
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    • "Other factors include history of chronic respiratory disorder such as child or teen-aged wheezer or adolescent onset asthma [14,27]. Moderate obese (16%) and extreme obese children (32%) are likely to have more GERD comparing to normal weight children [12]. "
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    ABSTRACT: Gastro-esophageal reflux disease (GERD) in otherwise healthy older children and adolescents is commonly encountered in pediatric clinics and poses a complex treatment problem involving changes of diets and lifestyle. After an initial history taking and a physical examination, typical symptoms of GERD in older children and adolescenct are initially treated with the trials of acid suppressants. With an increase of severe cases, more and more GERD children have been evaluated with endoscopy, which helps to delineate an erosive esophagitis from a non-erosive reflux disease as they are presumed to have different pathogenesis. For the pediatric patients without a significant underlying disease, a reflux esophagitis can be treated adequately with acid suppressants. Recently, the rapid increase of children who are taking anti-reflux medication has brought up a serious alarm among pediatricians. Some at risk pediatric patients with recurrent and/or chronic GERD have been linked to adulthood GERD. In this paper, pediatric GERD with and without erosive esophagitis was reviewed along with treatment options and issues specifically for the otherwise healthy older children and adolescents in the primary clinics or the secondary hospitals.
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