Gastroesophageal reflux is the process of involuntary reflux of stomach contents, which is with us from the first meal to the last meal of life, is repeated at every meal, can be essentially physiological and sometimes pathological.
It is one of the common problems of childhood. During infancy, 70% of babies vomit in the first month, 50% in the first three months, and 5-10% in the twelfth month. However, this vomiting usually remains at a physiological level.
The relationship between the esophagus and stomach of newborns and infants is different from that of adults. Although the esophagus is shorter, the muscular structure of its lower part is not fully mature. Again, the curved spring structure between the stomach and the esophagus, which is present in adults, is not present in babies. For this reason, stomach contents escape back into the esophagus more easily.
However, if gastroesophageal reflux causes weight loss, feeding refusal, inability to gain sufficient weight and restlessness in infants and children, it may cause abdominal pain, growth retardation and belching in older children. If it causes pain and burning in the area that fits into the esophagus, it is considered pathological. This condition is called gastroesophageal reflux disease.
Findings of gastroesophageal reflux disease outside the digestive system; Chronic cough, recurrent ear and lung infections, pharyngitis, laryngitis, rough and hoarse voice while sleeping, persistent wheezing, nodules on the vocal cords and respiratory arrests called apnea in babies. Gastroesophageal reflux disease can also lead to sudden infant death syndrome.
According to the latest data available today, there is no method that can be considered the golden criterion in diagnosis. Taking a good history of the patient, detailed physical examination and moving from treatment to diagnosis according to the findings (seeing whether the findings improve after the given reflux treatment), 24-hour pH measurement of the esophagus (the method of placing a microelectrode that measures pH from the nose of the baby or child to the lower part of the esophagus), Endoscopy and biopsy, barium contrast radiography, and bronchoscopy in which the vocal cords and bronchi are evaluated are among the diagnostic methods.
Treatment is divided into three: lifestyle changes, drug treatment and surgical treatment. Lifestyle changes are of great importance in treatment. Especially with a baby who gains more weight than normal Opening the feeding intervals prevents reflux and allows the baby to fully digest breast milk or formula, facilitating digestion. The digestion time of breast milk is 2-2.5 hours, and the digestion time of formula is 2.5-3 hours. Under one year of age, sleeping position and bedside height (above shoulder level) are also important in treatment.
In older children and adolescents, avoiding foods containing caffeine such as coffee, chocolate, alcohol, cigarettes and spicy foods helps reduce reflux. Lying on the left side and with the head above shoulder level may be beneficial for the treatment.
In cases where your doctor deems it necessary, drug treatment is started and the response to treatment is evaluated.
Surgical treatment is due to the stomach contents escaping into the respiratory tract ( aspiration), in life-threatening situations such as respiratory arrest, concomitant congenital heart disease or neurological disease, or in patients with developmental delay, asthma that does not respond to treatment and therefore triggers severe asthma attacks, and in those at risk of developing cancer in the esophagus due to recurrent severe reflux (Barrett esophagus) is recommended.
As a result, gastroesophageal reflux and gastroesophageal reflux disease are multifaceted conditions that need to be evaluated according to age, nutrition and living conditions, anatomical characteristics and need long-term follow-up. Collaboration between the child, family and doctor is essential in the management of this disease.
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