TY  - CHAP
M1  - Book, Section
TI  - Chapter 16. Gastroenterology
A1  - Lowry, Adam W.
A1  - Bhakta, Kushal Y.
A1  - Nag, Pratip K.
Y1  - 2011
N1  - 
T2  - Texas Children's Hospital Handbook of Pediatrics and Neonatology
AB  - Definitions:  Gastroesophageal  reflux  (GER)  is  normal  passage  of  gastric  contents  into  the  esophagus;  GERD  consists  of  symptoms  and  complications  of  GER;  rumination  is  voluntary  habitual  regurgitation  of  gastric  contents  into  the  mouth  for  self-stimulation.  Complications  of  GERD  can  be  divided  into  three  systems:  Respiratory  (asthma  and  /chronic  cough,  apnea  and  ALTE,  recurrent  aspiration  pneumonia),  ENT  (hoarseness,  laryngitis,  sinusitis,  dental  erosions,  recurrent  OM),  and  GI  (esophagitis,  esophageal  ulcers,  esophageal  strictures,  Barrett's  esophagus).Prevalence  of  GER:  50%  in  infants  age  0–3  mo;  67%  in  children  age  4  mo;  5%  of  children  age  10–12  mo;  1.4–8.2%  in  children  age  3–17  yr  (Arch  Pediatr  Adolesc  Med.  1997;151:569).  The  prevalence  of  GERD  is  unknown.DiagnosisHistory  and  physical  exam:  A  thorough  H&P  is  sufficient  for  diagnosis.  The  clinical  presentation  is  based  on  the  age  of  the  child:  Infants  and  young  children  present  with  recurrent  vomiting,  arching  of  the  back  during  feeds  (Sandifer  syndrome),  irritability,  and  poor  weight  gain  (2°  to  vomiting  or  dysphagia).  Some  present  with  wheezing  or  chronic  cough,  recurrent  pneumonia,  upper  airway  symptoms  (eg,  recurrent  stridor),  apnea,  or  ALTE.Older  children  and  adolescents  present  with  heartburn  or  retrosternal  chest  pain  and  regurgitation.  Some  present  with  dysphagia,  hoarseness  of  the  voice,  weight  loss,  anemia,  wheezing  or  chronic  cough,  recurrent  pneumonia,  food  impaction,  and  Barrett's  esophagus  (rare).History:  Ask  for  details  of  meals  (type,  volume  and  frequency),  recent  change  in  appetite,  reflux  symptoms  after  feeding  (regurgitation,  pain,  irritable,  dyspepsia),  presence  of  blood  or  bile,  force  of  reflux,  blood  in  the  stool,  trends  in  weight  gain.  Social  history:  Tobacco  or  alcohol  use,  psychological  factors  (eg,  stressors,  anxiety,  depression).  PMH:  of  eczema,  neurologic  issues  (↑  or  ↓  tone,  hydrocephalus,  presence  of  shunt),  prematurity,  surgery,  ENT  disease.  Family  history:  Helicobacter  pylori  infection,  reflux,  atopic  disease.Signs  suggesting  non-GER  cause  of  vomiting:  Bilious  or  forceful  vomiting,  GI  bleeding,  diarrhea,  constipation,  abdominal  pain  or  distension,  fever,  lethargy,  HSM,  seizures,  micro-  or  macrocephaly,  FTT,  genetic  d/o  (trisomy  21),  other  chronic  diseases  (eg,  HIV).Laboratory  studies/evaluation:  None  are  required  for  the  diagnosis  of  GERD.  Consider  H.  pylori  stool  antigen  testing  for  children  and  adolescents  if  the  patient  c/o  abdominal  pain  ±  dyspepsia  or  vomiting.  In  unclear  cases,  consider  UGI  to  r/o  anatomical  abnormalities,  esophageal  pH  monitoring  or  multichannel  intraluminal  impedance  may  be  used  to  correlate  reflux  with  symptoms;  esophagoscopy  may  be  used  for  complications  (strictures,  esophagitis)  and  to  rule  out  anatomic  abnormalities.TreatmentPhysiological  GER:  ReassuranceGERD  in  infants:  Step  1:  Thicken  formula  or  breast  milk  with  rice  cereal  (add  1  Tbsp/oz  of  formula),  reflux  precautions  (ie,  sleeping  supine  at  a  30-  to  45-degree  angle,  small  frequent  feeds,  frequent  burping,  maintain  upright  position  for  30  min  after  feeding).Step  2:  If  step  1  interventions  fail,  add  pharmacologic  therapy:  H2R  antagonist  (eg,  ranitidine)  or  PPI  (eg,  lansoprazole;  not  currently  FDA  approved).  PPIs  are  more  effective  at  acid  suppression  and  are  most  effective  if  given  30  min  before  morning  feeds.Surface  agents  (eg,  sucralfate,  sodium  alginate)  help  protect  ulcerated  gastric  mucosa.  Consider  use  in  infants  with  esophagitis  or  ulcers.Consider  changing  to  casein  hydrolysate  formula  (ie,  Nutramigen,  Alimentum,  Pregestemil)  if  milk-protein  allergy  is  strongly  suspected  as  the  cause  of  ...
SN  - 
PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2024/04/20
UR  - accesspediatrics.mhmedical.com/content.aspx?aid=7437895
ER  -