Pediatric Surgery Specialist Prof. Dr. Feryal Gün Soysal explained what you need to know about gastroesophageal reflux disease and its treatment in children.
The movement of stomach contents towards the esophagus is called gastroesophageal reflux disease (GERD). It may be a sign of GERD if the baby or child's stomach contents come out of the mouth without any effort, especially in the lying position.
Although GERD is common in the newborn and infancy period, it gradually decreases as the child grows. This is because; It is the increase in lower esophageal sphincter (LES) pressure, the length of the intra-abdominal part of the esophagus lengthening, and the baby starting to sit.
There is a balance between the reasons that enable and prevent GERD disease. This is called the antireflux mechanism. This mechanism is created by LES, Angle of Sense, sufficiently long intra-abdominal esophagus, compressive effect of diaphragmatic crus, mucosal folds (esophageal clearance), and intra-abdominal pressure. The most important factor that causes GERD is improper relaxation of the LES.
It varies depending on the age of the child
The clinic of newborns, infants and older children is different. . While vomiting, cough, wheezing, and recurrent aspiration pneumonia are observed in YD and infants, regurgitation (bitter water coming to the mouth), burning in the chest, pain, difficulty in swallowing, and growth and developmental delay are observed in older children.
Barrett's esophagus: lining the distal esophagus. It is the transformation of squamous epithelium into columnar epithelium. It is accompanied by esophageal stricture in half of the children.
Sandifer syndrome: The child with GERD moves his head, neck and sometimes his body meaninglessly. This condition, which increases while feeding, disappears while the child sleeps.
30-65% of children with esophageal atresia have GERD.
How is it diagnosed?
There is no need for another diagnostic method to start treatment in children with symptoms and findings compatible with GER. Auxiliary diagnostic methods are needed to investigate anatomical disorders in patients who do not respond to medical treatment and who will undergo surgical treatment.
Esophagography: Its main purpose is to investigate structural anomalies and measure gastric emptying time. After half of the stomach is filled with contrast material, the head is placed slightly downwards. It is pulled in the same position. GER is detected radiologically in only 30-35% of GER detected with a pH meter.
pH monitoring: It is the gold standard for GER. Data such as the frequency of reflux episodes lasting longer than 5 minutes, the duration of the longest episode, and the percentage of the time the pH is below 4 per 24 hours are recorded.
Endoscopy: The most important and primary indication is the suspicion of esophagitis. (+/- biopsy)
Manometric studies: The most important finding in favor of GER is low LES pressure.
How is it treated?
Medical treatment: If babies with GERD can continue their normal development, the symptoms disappear by changing feeding habits (such as thickening the formula and feeding frequently and little by little) and adjusting the lying position to 45 degrees. Medical treatment should be started in patients who do not respond to empirical treatment within 3-4 weeks.
Surgical treatment: Indications for surgical treatment are failure to control reflux with medical treatment in infants and children, complications related to esophagitis in older children (such as chest pain, dysphagia, anorexia, weight loss), and hiatus hernia and esophageal problems at any age. The presence of stricture.
The frequency of major complications of surgical treatment is 4.2-11.8%. Complications; brid ileus, separation of fundoplication, paraesophageal hernia, vagus or organ injury, inability to vomit, inability to burp.
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