GASTROESOPHAGEAL REFLUX NGWATU P - PowerPoint Presentation

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GASTROESOPHAGEAL REFLUX

NGWATU P

PAEDIATRIC GASTROENTEROLOGIST

LPR

the retrograde flow of stomach content to the larynx and pharynx whereby this material comes in contact with the upper

aerodigestive

tract.

is associated with symptoms of laryngeal irritation such as throat clearing, coughing, and hoarseness.

The most common

laryngoscopic

signs are redness and swelling of the throat

physiological barriers to LPR

LES

ESOPHAGEAL CLEARANCE influenced by esophageal peristalsis, saliva and gravity,

and

the UES.

stomach content comes in contact with the laryngopharyngeal tissue, causing damage to the epithelium, ciliary dysfunction, inflammation, and altered sensitivity

GER

the

passage of

gastric

contents into the esophagus with or without regurgitation and/or vomiting

.

GERD

symptoms of infant GERD vary widely and may include excessive crying, back arching, regurgitation and

irritability

.

Many of these symptoms, however, occur in all babies with or without GERD,

making a definitive diagnosis challenging

.

Non acid reflux

Nonacid reflux has been associated with inflammation in both LPR and

GERD

The reflux of duodenal-gastric juices contains bile acids and pancreatic secretions and can reach the

larynx

pepsin is actively transported into laryngeal epithelial cells and remains stable at pH 7.4, but is irreversibly inactivated at pH 8. After pepsin is reactivated by a decline from pH 7.4 to pH 3, 72% of peptic activity remains.

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history

The history should include the age of onset of symptoms, a thorough feeding and dietary history (e.g. length of feeding period, volume of each feed, type of formula, quality of milk supply when breast feeding, methods of mixing the formula, size of the feeds, additives to the feeds, restriction of allergens, time interval between feeding), the pattern of regurgitation/spitting/vomiting (e.g. nocturnal, immediately post prandial, long after meals, digested versus undigested), a family medical history, possible environmental triggers (including family psychosocial history and factors such as tobacco use and second-hand tobacco smoke-exposure), the patient’s growth trajectory, prior pharmacologic and dietary interventions and the presence of warning signs

Endoscopy and Biopsy

EGD has three roles in the evaluation of symptomatic children: to diagnose erosive esophagitis, to diagnose microscopic esophagitis, and to diagnose other conditions mimicking GERD

.

GERD may be present despite normal endoscopic appearance of the esophageal mucosa as well as in the absence of histological

abnormalities

Barium Contrast Radiography (Upper GI Series)

Not useful for the diagnosis of

GERD

reflux

events can be detected in as many as 50% of children undergoing radiologic imaging, regardless of

symptoms

Useful for the diagnosis of upper gastrointestinal tract anatomic abnormalities such

as esophageal

stricture, hiatal hernia, intestinal

mal-rotation

, achalasia,

tof

,

pyloric stenosis

Nuclear Scintigraphy

May

have a role in patients with chronic or refractory respiratory symptoms, to diagnose

pulmonary aspiration of refluxed gastric contents

Not routinely recommended in patients with other potentially reflux-related symptoms

Prokinetics

The

potential benefits (i.e. reduction of reflux-related symptoms, in

particular, regurgitation

or vomiting) of currently available

prokinetic

agents are outweighed

by their

potential side effects

There is insufficient evidence to support the routine use of

metoclopramide,erythromycin

,

bethanechol

or

domperidone

for GERD

buffering agents

chronic therapy

with

alginates and

sucralfate

is not recommended for GERD

microbiome

pre-and probiotics have not been adequately studied and may pose more risk and cost so therefore cannot be recommended for the reduction of symptoms of GERD in infants and children.

Surgery

Should be considered only in children with an established diagnosis of GERD

and failure

of optimized medical therapy

;

or

long-term dependence on medical therapy

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